A study on the relapse and its potential causes in pulmonary tuberculosis

A retrospective cohort study was conducted to acquire the general picture of relapse in pulmonary tuberculosis in China and to clarify the relationship between potential causes and relapse rate. All data were collected from 4,797 initial sputum-positive cases. Results showed: (1) Bacteriological relapse rate within two years after chemotherapy was 4.6%. (2) Cumulative relapse rates within half a year and a year only accounted for respectively 28% and 43% of that within two years after chemotherapy. (3) Patients over 60 years old, with drug-resistant bacilli, with long excretion of bacilli, or with residual cavity(ies) or bacterial-negative conversion of less than 3 months at the end of treatment, were the high risk population of relapse.     

Significance of serum surfactant protein-D (SP-D) level in patients with pulmonary tuberculosis

BACKGROUND: In 1992, 15 employers in Minneapolis-St Paul, operating as the Business Health Care Action Group (BHCAG), combined their self-insured plans. To successfully bid for the BHCAG contract, three competing group practices and a health plan cooperated, operating like a fully integrated care system to measure outcomes, develop practice guidelines, and meet other BHCAG requirements. To accomplish this, a new organization, the Institute for Clinical Systems Integration (ICSI), was conceived. ICSI IN THE EVOLVING MINNEAPOLIS MARKETPLACE: From a business standpoint, ICSI members stood to gain market share by being members of ICSI and the "chosen" consortium. From a professional standpoint, they could realize the fulfillment and satisfaction of knowing that they were innovating, improving care, reducing waste, and sharing their knowledge with others. A NEW MARKET MODEL: To drive the same kind of change for the entire care delivery system in the region, not just for the subset that happened to win the original bid, BHCAG changed the purchase model in February 1995--enrollees could now choose among 16 to 20 discrete care delivery systems instead of preferentially channeling them to the ICSI-HealthPartners network of group practices. All the care systems had become competitors on every level, including quality of care. The "special" customer-supplier relationship between BHCAG and the ICSI medical groups was no longer present. LESSONS LEARNED: Despite major changes in the market dynamics, with the marked decline in the business reason for collaboration which had prompted ICSI to form in the first place, physicians, nurses, and administrative staff from participating medical groups continue to devote massive effort to the development and implementation of best practices.     

Cytological studies in pulmonary pathology

Cytological investigations of the bronchial secretion and sputum in particular have acquired in recent years a great practical significance in pulmonary pathology. It is recommended to use cytodiagnosis along with prophylactic X-ray examinations of the population to detect pulmonary pathology, in particular among individuals with a higher risk of developing cancer. A substantiated opinion is put forward that cytodiagnosis should precede examinations of patients with clinico-roentgenologically confirmed changes in the lungs.     

The pathology of the pulmonary arteries in lung tumors

A study was undertaken to analyse the type and extent of pathological changes in the pulmonary arteries in non-small cell malignant tumours of the lung. Large-section histological preparations were made from 33 squamous cell carcinomas and 30 adenocarcinomas (T1 and T2 tumours) and classified according to tumour margin area (zone 1), intermediate area (zone 2) and tumour centre (zone 3). Transmural tumour growth with intraluminal cell formations in the pulmonary artery branches were found in the centre of all adenocarcinomas and 86% of squamous cell carcinomas, involving subsegment, prelobular and lobular arteries. Obstructive and obliterative changes in the pulmonary arteries as the result of tumour compression and secondary fibrosing changes predominantly occurred in the centre of all tumours. They were less common and less marked in zones 1 and 2. -Pulmonary artery branches in lung tumours of stages T1 and T2 showed marked infiltrating, obliterative and secondary inflammatory changes as far as complete vascular occlusions. These observations indicate that cytotoxic drugs, introduced via the systemic circulation, cannot reach and therefore not exert their effects in extensive areas of tumour.     

Predictive factors of Mycobacterium tuberculosis infection and pulmonary tuberculosis in prisoners

BACKGROUND: Tuberculosis currently represents a serious problem in prison populations. METHODS: With the aim of studying the predictive factors for, and the prevalence of, Mycobacterium tuberculosis infection and pulmonary tuberculosis in a Spanish prison, all those admitted during 1991 and 1992 were included (N = 1314). The tuberculin skin test, HIV serology, chest X-ray and bacteriological examination of sputum were carried out. Statistical analysis was done by univariant tests, stratified analysis and logistic regression. RESULTS: The prevalence of M. tuberculosis infection was 55.5% (95% confidence interval [CI] 52.5-58.5). An association was found with sex, imprisonment more than once, HIV infection and age. The co-infection rate (tuberculosis plus HIV) was 9.2%. Logistic regression showed a greater risk with age (4.4% per year), time spent in prison and for males. The prevalence of pulmonary tuberculosis was 1.26% and an association was found with M. tuberculosis infection, HIV infection (odds ratio [OR] = 13.7), intravenous drug users (OR = 17.2) and imprisonment more than once (OR = 7.3). Logistic regression showed an association with HIV co-infection (OR = 20.2). CONCLUSIONS: The prevalence of M. tuberculosis infection and pulmonary tuberculosis is high when compared with similar studies. The influence of age, time spent in prison and co-infection with HIV is relevant to recommendations for specific tuberculosis prevention programmes in correctional facilities.     

Right ventricular pathology in chronic pulmonary hypertension

Right ventricular free wall biopsy specimens in 40 patients undergoing surgery for relief of chronic thromboembolic pulmonary hypertension were normal in 5%, disclosed only myocyte hypertrophy in 80%, mild focal fibrosis in 12.5%, and myocarditis in 2.5%. There was no relation between postsurgical functional or hemodynamic outcomes and the presence of focal fibrosis.     

Problems in the treatment of patients with pulmonary tuberculosis

The paper presents the current approaches to chemotherapy in patients with pulmonary tuberculosis and shows the main reasons that do not allow one to achieve high outcomes of treatment. These involve the drug resistance of Mycobacterium tuberculosis, the morphological features of a specific process in the lung, the higher incidence of acutely progressive types of pulmonary tuberculosis in particular; tuberculosis-contaminant diseases (diabetes mellitus, gastrointestinal, hepatic, renal diseases, and non-specific respiratory diseases, etc.). Recommendations how to eliminate the reasons for ineffective treatment of pulmonary tuberculosis are given.     

Differential diagnosis of pulmonary tuberculosis

Differential diagnosis of pulmonary tuberculosis is discussed. Chest X-ray findings of pulmonary tuberculosis may be greatly varied, because tuberculosis may cause three different lesions: an exudative lesion, a proliferative lesion, and a fibrotic lesion, and because it may invade all the structure. Thus, the differential diagnosis of pulmonary tuberculosis includes very many diseases. The most important differential diagnosis of nodule is tuberculoma and lung cancer. The clue of the diagnosis is the feature of the nodule and surrounding structure, such as pleural indentation, or knotching. There is, however, the limitation of the diagnosis by imaging: some tuberculoma may show the identical feature with the pulmonary adenocarcinoma. It is important to gather the pathological or bacteriological evidences by means of suitable procedures.     

Current concept in the diagnosis and treatment of childhood pulmonary tuberculosis

In India, an estimated 80% of children are infected with tubercle bacillus by 10 years of age. Elimination of tuberculosis depends on finding all infectious patients and providing them with curative chemotherapy. Pulmonary tuberculosis--the most common form in children--is diagnosed when a child presents with fever, prolonged cough, weight loss, recurrent wheezing, or chest infection; the chest x-ray is suggestive of tuberculosis; and three or more of the following conditions exist: 1) Mantoux test result of 10 mm or more, 2) tuberculosis lymphadenitis by fine needle aspiration cytology, 3) grade III malnutrition, 4) no BCG vaccination, 5) positive family history of tuberculosis, and 6) recent history of pertussis or measles. Recommended, for children with pulmonary tuberculosis, is a regimen of isoniazid, rifampicin, and pyrazinamide daily for 2 months, followed by the first two drugs daily for an additional 4 months. The poor tuberculosis cure rates in most developing countries reflect patient non-compliance with treatment regimens.     

The course of pulmonary tuberculosis in adolescents

The authors summarize data obtained at the examinations of 178 tuberculous adolescents aged 15-17. Primary forms of the disease were diagnosed in 52% of new-onset cases, while infiltrative tuberculosis prevailed among secondary forms (48%). The tuberculosis was detected at prophylactic fluorography in 63.5% of the examinees. Late disease diagnosis was mostly consequent to poor symptoms of tuberculosis.