Clinical and bronchoscopic features of endobronchial tuberculosis

A mobile educator unit is a cost-effective teaching tool that can be easily implemented in an acute hospital setting to assist in teaching patients, visitors, and personnel about health and wellness. The educator unit cannot replace the face-to-face interactions between professional and patient or visitor, but it can supplement and make information more readily available than a stationary display.     

Operative treatment of the endobronchial tuberculosis with cicatricial bronchiarctia

OBJECTIVE: The experience of surgical treatment in 32 patients with cicatricial brochiarctia by endobronchial tuberculosis was reported. METHOD: The modes of surgical treatment in the series include: sleeve resection was done in 19 cases, lobectomy in 4 cases, pneumonectomy in 7, and left principal bronchial reconstruction in 2 cases. RESULTS: The results were excellent and without operative death. Serious postoperative complication was bronchopleural fistula in one case. The patient was treated by surgical repair of the bronchial stump and buttressed with vascularized pedicle flaps of omentum in the second operation. 2 cases of 32 patients were affected with mild stenosis of bronchial anestomosis after a follow-up of 12 to 18 months. CONCLUSIONS: It was suggested that when the patient developed the endobronchial tuberculosis with cicatricial bronchiarctia, corrective operation should be performed as early as possible, and the sleeve resection should be the first choice.     

Rapid diagnosis of Mycobacterium tuberculosis bacteremia by PCR

A method based on DNA amplification and hybridization has been used for the rapid detection of Mycobacterium tuberculosis in blood samples from 38 hospitalized patients (15 human immunodeficiency virus [HIV] positive and 23 HIV negative) in whom localized or disseminated forms of tuberculosis were suspected. In 32 of these patients, the diagnosis of tuberculosis was eventually confirmed by conventional bacteriological or histological procedures. M. tuberculosis DNA was detected with the PCR technique in the peripheral blood mononuclear cells from 9 of 11 (82%) HIV-infected patients and in 7 of 21 (33%) HIV-negative patients (P < 0.01), while M. tuberculosis blood cultures were positive in 1 of 8 (12.5%) and 1 of 18 (5.5%) patients, respectively. PCR was positive in all cases with disseminated disease in both HIV-negative and HIV-positive patients and also in the HIV-positive patients with extrapulmonary tuberculosis. Seven samples from patients with documented illness other than tuberculosis and 12 specimens from healthy volunteers, including seven volunteers with a recent positive purified protein derivative test, were used as controls and had a negative PCR. These results suggest that detection of M. tuberculosis DNA in peripheral blood mononuclear cells may be a useful tool for rapid diagnosis of disseminated and extrapulmonary forms of tuberculosis, especially in an HIV-positive population.     

Single local injection of recombinant fibroblast growth factor-2 stimulates healing of segmental bone defects in rabbits

One type of maturity-onset diabetes of the young (MODY2) is caused by mutations in the glucokinase gene, a key glycolytic enzyme in the beta cell and liver. Glucose fails to stimulate insulin secretion in mice in which the glucokinase gene has been selectively knocked out in the beta cell. We tested the hypothesis that this effect results from defective metabolic regulation of beta cell ATP-sensitive potassium (K(ATP)) channels. Glucose had little effect on K(ATP) currents in homozygous (-/-) mice but inhibited K(ATP) currents in wild-type (+/+) and heterozygous (+/-) mice with EC50 of 3.2 mM and 5.5 mM, respectively, in newborn animals, and of 4.7 mM and 9.9 mM, respectively, in 1.5-year-old mice. Glucose (20 mmol/l) did not affect the resting membrane potential of -/- beta cells but depolarised wild-type and + /- beta cells and induced electrical activity. In contrast, 20 mmol/l ketoisocaproic acid or 0.5 mmol/ l tolbutamide depolarised all three types of beta-cell. These results support the idea that defective glycolytic metabolism, produced by a loss (-/- mice) or reduction (+/- mice) of glucokinase activity, leads to defective K(ATP) channel regulation and thereby to the selective loss, or reduction, of glucose-induced insulin secretion.     

Intestinal tuberculosis: clinicopathologic analysis and diagnosis by endoscopic biopsy

OBJECTIVES: Tuberculosis is still an important cause of granulomatous colitis in developing countries. If we can diagnose tuberculosis using endoscopic biopsy material, clinicians can avoid invasive diagnostic procedures and needless operations. For this purpose, we evaluated clinical manifestations, pathological findings, and diagnostic methods in endoscopically biopsied intestinal tuberculosis patients. METHODS: From January 1991 to December 1996, 42 patients with intestinal tuberculosis were endoscopically examined and tissue culture, immunohistochemical stain, Ziehl-Neelsen stain, and polymerase chain reaction in fresh and fixed tissue were applied. The pathological findings were analyzed and compared with the results of the other diagnostic methods. RESULTS: In tuberculosis patients, transverse ulcers with surrounding hypertrophic mucosa and multiple erosions were usual colonoscopic findings. The granulomas were found in 74% of the cases. The positivity ranged from 30-45%. There were no significant differences in the positivity among those diagnostic methods (p > 0.05). The positivity of Ziehl-Neelsen stain in fixed tissue was higher in the group having granulomas and it was reversed in PCR (p < 0.05). The increasing number of biopsy particles raised the positivity of Ziehl-Neelsen stain and PCR in fixed tissue (p < 0.05). CONCLUSIONS: Transverse ulcers were the most characteristic colonoscopic finding and granulomas were frequent pathological findings in intestinal tuberculosis. Higher positivity and reliable results were found in tissue culture, Ziehl-Neelsen stain, and polymerase chain reaction. To increase the diagnostic rate, the endoscopist should take enough tissue and deep biopsy material from ulcer bases and diseased mucosae.     

Rapid method for testing susceptibility of Mycobacterium tuberculosis by using DNA probes

The increasing number of multidrug-resistant Mycobacterium tuberculosis strains has stimulated the interest of investigators in finding a rapid method for susceptibility testing. We used commercially available rRNA DNA-bioluminescence-labelled probes (Accu-Probe, Gen Probe, Inc. San Diego, Calif.) for this purpose. The study was performed in three chronological steps. (i) We studied the correlation between the photometric light units (PLUs) given by the hybridization method, the numbers of CFU per milliliter, and turbidity as nephelometric units for six different inocula of an M. tuberculosis strain over 14 days. A good correlation (c > 0.9; P < 0.05) was found from the third day for all concentrations used. (ii) Over a period of 14 days we studied the evolution of the PLUs for 20 strains growing in medium with 0.2 microl of isoniazid (H) per ml and 18 strains in medium with 1 microl of rifampin (R) per ml to standardize the method. Susceptible and resistant strains were used according to the reference proportions method in Middlebrook 7H10, and the MICs were determined in solid and liquid media. The final inoculum of a 10(-2) dilution from a McFarland no. 1 standard and reading at 3 and 5 days provided the best results. A quotient was established to find a cutoff point between resistant and susceptible strains. (iii) We used the standardized parameters in 117 tests with H and R. On day 3, the sensitivity, specificity, positive predictive value, and negative predictive value for detecting resistant strains were 86.8, 100, 100, and 90.1%, respectively, and on day 5 they were 96.2, 100, 100, and 94%, respectively. We concluded that the method is readily available, is easy to perform, and could be useful for screening resistant M. tuberculosis strains.     

Rigidity of dental local anaesthetic injection needles

OBJECTIVE: To study mechanism of bronchial hyperresponsiveness (BHR) and the relationship between asymptomatic BHR and asthma. METHODS: Bronchial biopsies were taken through fiberoptic bronchoscope from 17 cases of asymptomatic BHR, 12 cases of chronic asthma with remission and 10 normal control subjects. Bronchial mucosas were investigated by light microscopy and transmission electron microscope. Analysed by morphometric technique for the granules in both eosinophils (EOS) and mast cells (MC). RESULTS: Airway allergic inflammation (AAI) existed in 9 cases (53%) with asymptomatic BHR. It was similar in bronchial mucosal pathologic changes to chronic asthma with remission. Inflammation existed in the other 8 cases (47%), but unlike AAI, there were no infiltration of EOS and MC in bronchial mucosa. CONCLUSIONS: The pathological changes of asthma in bronchial mucosa were existed in a part of patients with asymptomatic BHR.     

Rapid cultivation of Mycobacterium tuberculosis in liquid medium

A total of 894 specimens have been examined by the rapid method for Mycobacterium tuberculosis. The medium used for the rapid isolation was Veeraraghavan's modified medium V (T2). It is a rich synthetic medium consisting of amino acids, salts and vitamins. It enables the growth of mycobacteria within 48 hrs. The study was carried out to compare the results of Veeraraghavan's liquid medium with LJ medium in routine clinical laboratory. The results of this study indicate that the rapid method gives consistently better results than those obtained by the standard method. The results compare well with the findings of Daginawala and Banker.     

Rapid diagnosis of tuberculosis using the amplification method

BACKGROUND: Amplification methods identify Microbacterium tuberculosis on the basis of genus- or species-specific sequence of bases in nucleic acids which they replete exponentially. The objective of the work was comparison of results of biological samples by the method Gen-Probe Mycobacterium tuberculosis Direct Test (MTD) using amplification of ribosomal RNA and BK by microscopy and cultivation, assessment of standard indicators of their efficiency of the method and analysis of diverging results. METHODS AND RESULTS: During the period between April 19, 1994 and October 19, 1995 a total of 650 specimens from 316 patients examined for suspected tuberculosis were processed. After decontamination the specimens were divided into two portions and examined by the Gen-Probe MTD and by classical BK microscopy and cultivation. 95 specimens were Gen-Probe MTD positive. As compared with BK cultivation the sensitivity of Gen-Probe MTD is 94.7%, the specificity 93.1%, the positive predictive value 56.8% and the negative predictive value 99.5%. Falsely positive were the specimens from 33 patients, most frequently with a diagnosis of tumours, non-specific bronchopneumonias and interstitial pulmonary fibroses. CONCLUSIONS: Gen-Probe MTD is a rapid examination with an equal or higher sensitivity than BK cultivation. The disadvantage is a somewhat lower specificity and higher cost.     

Long-term effect of prophylactic endoscopic injection sclerotherapy on liver function

BACKGROUND/AIMS: The aim of this study was to investigate the long term effect of prophylactic endoscopic injection sclerotherapy (EIS) on liver function. METHODOLOGY: This study was a retrospective investigation of seventy-eight patients with liver cirrhosis, whose liver function was classified as Child's A before follow-up. Laboratory data were retrospectively examined before and after follow-up, and a comparison was made between the EIS group (n=21) and the non-treated group (n=57). RESULTS: In the 3 or more years of follow-up, cholinesterase and total cholesterol levels deteriorated in several severe-variceal cases. However, these levels did not deteriorate over the 3 or more years of follow-up in the EIS group. CONCLUSION: Prophylactic endoscopic injection sclerotherapy among patients with early stage LC may prevent the deterioration of liver function.     

Farewell to bacteremia caused by endoscopic injection--effectiveness of a new injection catheter with a covered tip

BACKGROUND: Endoscopic injection has recently been reported as effective for several treatments. Because the common channel (suction and biopsy) is usually contaminated with aspirated gastrointestinal juice containing bacteria, often the tip of the injector needle is also. We report a new catheter needle with a covered tip designed to prevent bacteremia from endoscopic injection. METHODS: The new covered needle catheter (Clisco needle) has a 23-gauge retractable needle with a 3 mm extrusion in one lumen. Its distal tip is covered with rubber, blocking infiltration of contaminated gut juice. Ten of these catheters and 10 other disposable needles were inserted through the colonoscope's biopsy channel for 10 patients. Needle tips were cut off after extrusion, and bacteria cultured were counted by standard plate count method. RESULTS: All cultures from ordinary needles grew Escherichia coli, whereas only 3 new needles grew E. coli. Average counts of bacteria cultured from these 3 catheters and 10 disposable needles were 1-250 and 90-6.1 x 10(6), respectively. The difference was highly significant (p < 0.0001). CONCLUSIONS: This new covered needle catheter reduces contaminating bacteria in patients who require endoscopic injection and may prevent bacteremia without antibiotic prophylaxis.     

微乳液增溶流动注射分光光度法快速测定柴油中铜

研究了在乳化剂OP-正丁醇-正庚烷-水构成的微乳液介质中,利用微乳液的增溶作用,以2-(5-溴-2-吡啶偶氮)-5-二乙氨基苯酚(5-Br-PADAP)为显色剂,用流动注射分光光度法直接测定柴油中微量铜。在测定波长558 nm处,铜量在0~2.0μg/mL范围内符合比尔定律,相关系数r为0.998 2,进样频率为180/h。本方法不必对柴油预处理,可直接进行测定,加标回收率为102.5%,103.2%,相对标准偏差为2.91%,2.58%。     

Role of endoscopic injection therapy in the treatment of bleeding peptic ulcer

Transforming growth factor beta (TGF beta) was examined regarding its regulation of the mitogen EGF. A431 human epidermoid carcinoma cells were treated with TGF beta and epidermal growth factor (EGF) (10 ng/ml each) to determine if TGF beta modulates EGF-induced Ca2+ signaling and c-Fos oncoprotein levels. Changes in [Ca2+]i were determined by digital imaging analysis or photon counting. In HBSS + Ca2+ (1.37 mM), EGF treatment resulted in a transient increase in [Ca2+]i from 75 to 150 nM, which lasted approximately 3.5 min and re-equilibrated to 90 nM. In nominally Ca(2+)-free (2-5 muM) HBSS, EGF caused a [Ca2+]i elevation that peaked at 140 nM and returned to baseline. TGF beta in HBSS + Ca2+ did not elicit a [Ca2+]i increase, although affinity labeling revealed types I, II, and III TGF beta receptors. TGF beta added simultaneously with EGF in HBSS + Ca2+ caused a gradual rise in [Ca2+]i from 50 to 100 nM over 16 min. Pretreatment with TGF beta (3 h; 10 ng/ml) abolished the EGF-induced [Ca2+]i elevation. EGF or TGF beta treatments increased c-Fos immunoreactivity by around 1 h. In summary, EGF elevated [Ca2+]i in the presence or absence of [Ca2+]e, resulting in high [Ca2+]n, associated with tyrosine and threonine phosphorylation, and increased c-Fos oncoprotein immunoreactivity. TGF beta did not increase [Ca2+]i but did increase c-Fos; TGF beta + EGF added simultaneously altered the EGF-induced [Ca2+]i elevation, and TGF beta pretreatment eliminated EGF-induced [Ca2+]i elevation. This suggests that TGF beta can regulate EGF in A431 cells and that increased c-Fos may not be mediated by Ca2+.     

Klebsiella pneumoniae panophthalmitis: a possible complication of endoscopic variceal injection sclerotherapy

Complication of endoscopic variceal injection sclerotherapy for esophageal variceal hemorrhage is not unusual. However, sclerotherapy complicated panophthalmitis was never reported before. We report such an unusual complication and discuss its possible mechanism and treatment.     

Is endoscopic injection hemostasis of bleeding gastrointestinal ulcers obsolete in 1995?

Bleeding non-neoplastic lesions of the upper gastrointestinal tract, not due to portal hypertension, are a frequent cause of emergency admission. In the present paper we report our retrospective experience in hemostatic injection treatment of these lesions. From May 1990 to May 1994, 164 patients were admitted to our institution for a bleeding gastrointestinal lesion. In 124 cases an ulcer classified according Forrest's criteria was detected. Four patients underwent immediate surgery. The second group of 86 patients (FIIa/FIIb/FIII) were treated conservatively. The third group of 34 patients (FIa/FIb/FIIa) underwent perilesional injection of adrenaline 1:10,000 and polidocanol 1% saline solution during endoscopic examination; 29% (25 pts) of the second group re-bled during the first 72 h vs 8.8% (3 pts) of the third group. The postoperative morbidity in the rebleeding patients was higher in the second group: 38.4% vs 0%. The importance of immediate, inexpensive, and simple hemostatic treatment extended to Forrest IIa lesions is emphasized.     

Rapid expression and specific localization of tenascin in gastric ulcer healing in rats

This study was done to investigate the gene expression and localization of tenascin in ulcerated gastric tissues during the healing process with Northern blot analysis and immunohistochemical technique. Gastric ulcers in rats were produced by acetic acid. Tenascin mRNA levels in the ulcerated tissue were significantly increased in a biphasic manner (12 h and day 5), preceding the increase in collagen type IV and laminin mRNA levels, and returned to control levels on day 11. In intact tissues, tenascin was mainly localized in the basement membrane above the proliferative zone, in contrast to the predominant localization of collagen type IV and laminin below the proliferative zone. On the ulcer margin from 12 h to day 5, tenascin was abundantly observed in the lamina propria around nonproliferating new epithelial cells, but collagen type IV and laminin were not seen in this lamina propria. On day 7, tenascin, expressed in the lamina propria, was replaced by collagen type IV and laminin. Thus, the rapid expression and unique localization of tenascin suggest the important role of tenascin in gastric ulcer healing.