Valor nutritivo de pastagens de Coastcross-1 em consórcio com diferentes leguminosas de ciclo hibernal / Nutritive value of coastcross-1 pastures mixed to different cool season legumes

Objetivou-se com esta pesquisa avaliar três sistemas forrageiros constituídos por Coastcross-1 (CC) + 100kg de N/ha/ano + ervilhaca comum; CC + 100kg de N/ha/ano + trevo vesiculoso; e CC + 200kg de N/ha/ano. Durante o período experimental (345 dias), foram realizados treze pastejos. O delineamento experimental utilizado foi o inteiramente ao acaso, com três tratamentos (sistemas forrageiros), três repetições (piquetes) em parcelas subdividas no tempo (valores médios dos pastejos em cada estação do ano). Para avaliação, foram utilizadas vacas em lactação da raça Holandesa. Amostras de simulação de pastejo foram coletadas para análise de proteína bruta (PB), fibra em detergente neutro (FDN) e ácido (FDA), digestibilidade in situ da matéria seca (DISMS) e da matéria orgânica (DISMO) e os nutrientes digestíveis totais (NDT). Os valores médios para PB, FDN, FDA, DISMS, DISMO e NDT foram de 18,1; 16,7 e 17,6%; 57,8; 58,9 e 58,7%; 26,5; 26,5 e 26,7%; 79,6; 78,9 e 80,6%; 79,8; 79,1 e 80,6%; 72,1; 71,4 e 72,7%, respectivamente. Melhores resultados de valor nutritivo foram obtidos no inverno, em especial para o consórcio de Coastcross-1 com ervilhaca.

The aim of this research was to evaluate three grazing systems with Coastcross-1 (CC) + 100kg N/ha/year + common vetch; CC + 100kg N/ha/year + arrowleaf clover; and CC + 200kg N/ha/year. Thirteen grazing cycles were performed during the experimental period (345 days). The experimental design was completely randomized with three treatments (grazing systems), three replicates (paddocks) in completely split-plot time (average values of grazing season). Lactating Holstein cows were used in the evaluation. Forage mass and botanical composition were evaluated. Samples from the hand-plucking method were collected to analyze crude protein (CP), neutral detergent fiber (NDF) and acid (ADF), in situ digestibility of dry matter (ISDMD) and organic matter (ISOMD) and total digestible nutrients (TDN). The averages of CP, NDF, ADF, ISDMD, ISOMD and TDN were 18.1, 16.7 and 17.6 %; 57.8, 58.9 and 58.7 %; 26.5, 26.5 and 26.7 %; 79.6, 78.9 and 80.6 %; 79.8, 79.1 and 80.6 %; 72.1, 71.4 and 72.7 %, respectively. Better results for nutritive value were found during winter, especially on Coastcross-1 mixed with common vetch.

Multifocal extraparotid Warthin's tumours mimicking metastatic squamous cell carcinoma of the upper neck.

BACKGROUND: Warthin's tumours can show features of pseudo-neoplasia. They do not usually cause problems for diagnosis and management when present within the parotid gland. However, extraparotid Warthin's tumours that are associated with pseudo-neoplasia upon cytological analysis can mimic metastatic malignant disease. The case of a patient presenting with multifocal extraparotid Warthin's tumours is described. CASE REPORT: A 57-year-old male smoker presented with rapidly growing upper neck lumps. Fine needle aspiration cytology, magnetic resonance imaging and positron emission tomography findings were compatible with metastatic squamous cell carcinoma secondary to either an unknown primary upper aerodigestive or a parotid malignancy. The patient subsequently underwent total conservative parotidectomy and modified radical neck dissection. Final histology findings revealed multifocal benign Warthin's tumours with four extraparotid components. CONCLUSION: Warthin's tumours may present outside the parotid gland, present with multifocal lesions and mimic metastatic disease. Frozen section examination prior to radical resection should be considered to guide management.

Produtividade de sistemas forrageiros consorciados com leguminosas / Productivity of grazing systems mixed with forage legumes

O objetivo desta pesquisa foi avaliar três sistemas forrageiros (SF) com capim elefante (CE) + azevém (AZ) + espécies de crescimento espontâneo (ECE); CE + AZ + ECE + amendoim forrageiro (AM); e CE + AZ + ECE + trevo vermelho (TV), usando-se a mesma área, sob pastejo rotacionado, no decorrer do ano agrícola. O CE foi estabelecido em linhas afastadas a cada 4m. No período hibernal, fez-se o estabelecimento do AZ entre as linhas do CE; o TV foi semeado e o AM foi preservado, considerando-se os respectivos SF. O delineamento experimental foi o inteiramente ao acaso, com três tratamentos (SF), duas repetições (piquetes) e avaliações independentes (ciclos de pastejos). Para avaliação, foram utilizadas vacas da raça Holandesa em lactação, que receberam suplementação alimentar com concentrado à razão de 1% do peso corporal/dia. Foram avaliados a massa de forragem, os componentes botânicos do pasto e estruturais do CE e a taxa de lotação. Durante o período experimental, foram efetuados oito ciclos de pastejo. Sistemas forrageiros que envolvem gramíneas e leguminosas de diferentes ciclos proporcionam a utilização da área durante todo o ano agrícola em pastejo rotativo com bovinos leiteiros. Considerando-se a predominância das avaliações em cada pastejo, os sistemas forrageiros consorciados apresentam melhor resultado tanto paras as variáveis de massa de forragem quanto para a taxa de lotação.

The objective of this research was to evaluate three grazing systems (GS) with elephant grass (EG) + ryegrass (RG) + spontaneous growing species (SGS); EG + RG + SGS + forage peanut (FP); and EG + RG + SGS + red clover (RC), in order to use the area in rotational grazing during the agricultural year. EG was planted in rows with a distance of 4m between each row. In the cool-season, RG was sowed between EG rows and FP was preserved on GS. The experimental design was completely randomized with three treatments (GS), two replicates (paddocks) and independent evaluations (grazing cycles). For the evaluation lactating Holstein cows receiving 1% of BW/day feed supplement concentrate were used. The herbage mass, botanical composition of pasture, structural component of EG and stocking rate were evaluated. Eight grazing cycles were performed during the experimental period. Grazing systems involving grass and legume forage in different cycles provided the use of the area during the agricultural year in rotational grazing with dairy cattle. Considering the predominance of the evaluations in each grazing, the mixed grazing systems have better results for both forage mass and stocking rate variables.

Eficácia do óleo de citronela [Cymbopogon nardus (L. ) Rendle] no controle de ectoparasitas de bovinos / Efficacy of citronella [Cymbopogon nardus (L. ) Rendle] oil in the control of bovine ectoparasites

O objetivo desta pesquisa foi avaliar o efeito in vivo do óleo de citronela, no controle do carrapato bovino [Rhipicephalus (Boophilus) microplus], da mosca-dos-chifres (Haematobia irritans), da mosca-dos-estábulos (Stomoxys calcitrans) e da mosca doméstica (Musca domestica). Foram utilizadas 15 vacas da raça Holandês, distribuídas em três grupos de cinco animais cada um. Os tratamentos foram: controle negativo, amitraz a 0,025 por cento e óleo de citronela a 4 por cento. Para avaliação foram contadas fêmeas ingurgitadas de carrapato e moscas antes (média dos dias -3, -2, -1) e após a aplicação dos produtos nos dias 7, 14, 21 e 28; também foram coletadas amostras de sangue. Em 28 dias, houve necessidade de se reaplicar o amitraz e o fitoterápico para controlar a infestação com carrapato. A relação entre o número de aplicações foi de 1:2,5 para o amitraz e o óleo de citronela, respectivamente. A eficácia no controle do carrapato foi de 71,8 e 30,9 por cento para o amitraz e óleo de citronela a 4 por cento, respectivamente, na média pós-tratamento. Verificou-se baixo controle de moscas no tratamento constituído pelo fitoterápico. Não houve diferença entre os tratamentos para os parâmetros sanguíneos.

This study aimed to evaluate the in vivo effect of citronella oil on the control of bovine ticks [Rhipicephalus (Boophilus) microplus], horn flies (Haematobia irritans), stable flies (Stomoxys calcitrans) and houseflies (Musca domestica). Fifteen Holstein cows were allocated to three groups of five animals each. The treatments were: negative control, amitraz at 0.025 percent and citronella oil at 4 percent. Engorged female ticks and flies were counted before (mean of days -3, -2, -1) and at 7, 14, 21 and 28 days after treatment; blood samples were also collected. Within 28 days, amitraz and the phytotherapic agent had to be reapplied to control tick infestation. The relationship among the number of applications was 1:2.5 for amitraz and citronella oil, respectively. The efficacy of tick control was, on average, 71.8 and 30.9 percent for amitraz and citronella oil at 4 percent respectively, post-treatment. Lower control of flies was observed for the phytotherapic group. There was no difference among treatments for blood parameters.

A clinical review of 128 cases of head and neck tuberculosis presenting over a 10-year period in Bradford, UK.

AIMS: To analyse the epidemiology, presentation and diagnosis of head and neck tuberculosis (TB). METHODS: We conducted a 10-year retrospective study of all cases of tuberculosis of the head and neck region occurring in Bradford, UK. RESULTS: Of a total of 1315 cases of TB, 128 presented with head and neck TB (12 per cent of which (15/128) were in children). Cervical lymph nodes were most commonly involved (87 per cent, 111/128), other sites being: salivary glands (five cases); larynx, oral cavity, eyes and ears (two cases each); and skin, thyroid, nasopharynx and retropharyngeal space (one case each). Patients' ethnic origins were Asian (89 per cent, 114/128), Caucasian (10 per cent, 13/128) and African (one case). Only 26 per cent (33/128) had constitutional symptoms, and 20 per cent (25/128) had a coexistent site of TB. Only 39 per cent (40/105) of surgical specimens were sent for culture. CONCLUSIONS: Isolated head and neck TB is not uncommon. Atypical presentations render diagnosis challenging, so awareness aids early diagnosis. Mycobacterial cultures should be performed, where possible, for diagnosis.

Role of information leaflets in improving the practice of informed consent for patients undergoing septoplasty.

AIM: To evaluate the effectiveness of an information leaflet in improving patient understanding of the procedure and complications of septoplasty. DESIGN: The baseline knowledge of a group of patients who had attended a pre-assessment clinic prior to septoplasty was assessed. The procedure and its complications were then verbally explained. The patients' knowledge was then re-assessed on the morning of surgery and any improvements noted. In the second arm of the study, an information leaflet was introduced at the time of verbal instruction and any differences in improvement in knowledge were assessed. RESULTS: Data from the two groups were analysed using an analysis of covariance with differences in baseline (pre-instruction) knowledge controlled. Additional improvements in mean recall score following leaflet distribution were highly statistically significant when compared with mean recall in the control group (p<0.001). CONCLUSION: The use of information leaflets increases patients' knowledge about a surgical procedure and its potential complications.

Is clinical otolaryngology publishing patient-centred research?

We asked how patient centred is Clinical Otolaryngology? Using two new models for analysing the patient-centredness of medical literature, three reviewers classified 176 papers (91 articles and 85 abstracts) published in this journal during the year 2000. Patients appeared as clinical subjects in 98 (56%), were interviewed by closed questionnaires in 21 (12%) and open questionnaires in 6 (3%), represented only by demographic details in 40 (23%) and not part of the study in 11 (6%) of papers. Papers were considered to address a biomedical frame of reference in 48 (27%), the patient's frame of reference in 6 (3%), technical aspects of the clinical encounter in 109 (62%) and communicative aspects in 7 (4%), and the setting for the encounter in 6 (3%) of papers. We show that some patient-centred research is published in Clinical Otolaryngology but suggest that it could publish more.

[Interest of periareolar injection for colorimetric detection of sentinel node in breast cancer]. / Intérêt de l'injection périaréolaire du colorant lymphotrope dans la recherche du ganglion axillaire sentinelle dans le cancer du sein.

Most teams working on sentinel node biopsy in the treatment of breast cancer inject either radioactive colloid or vital blue dye around the primary tumour. Many anatomical studies and lymphoscintigraphical studies, some very old, have shown that the lymphatic drainage of the breast is collected first in the periareolar plexus of Sappey, then routed to the axilla in 95% of cases, via one or two primary collectors. In a series of 94 breast cancers measuring less than 3 cm, with any palpable axillary lymph node, 2 ml of patent blue was injected intradermally around the areola, at the two meridians around the tumor. The sentinel node was identified in 89 cases (94,7%), regardless of the location of the primary tumor. All the sentinel nodes were located in the lower axilla. An average of 1.6 nodes were found per patient. In 41 cases, axillary lymph node dissection was performed either immediately (5 technical failures, 9 positive frozen section) or delayed only if the sentinel node was positive, either on standard H&E staining or on immunohistochemistry (27 cases). Thus, axillary lymph node dissection was not performed in 48 patients (55%). In positive node patient, the sentinel node was the only positive lymph node in 20 patients (55%). For 5 positive node patients, axillary lymph node dissection was not performed: poor vital status (2 micro-metastatic nodes) or by decision of patient (3 IHC positive nodes). With this periareolar injection procedure, the rate of detection is highly satisfactory and is comparable to that usually published with peritumoral injection. This procedure seems appropriate in all cases, regardless of the topography, the size or the multifocality of breast cancer.

Human immunodeficiency virus-positive tuberculous lymphadenitis in Central Africa: clinical presentation of 157 cases.

SETTING: University Teaching Hospital, Lusaka, Zambia. OBJECTIVE: To compare the clinical presentation of human immunodeficiency virus (HIV)-positive tuberculous lymphadenitis with primary HIV lymphadenopathy and HIV-negative tuberculous lymphadenitis. DESIGN: Prospective study of patients undergoing diagnostic lymph node biopsy, with details of lymph node distribution, character and size assessed immediately before biopsy. RESULTS: In total, 157 patients with HIV-positive tuberculous lymphadenitis, 71 with primary HIV lymphadenopathy and 28 with HIV-negative tuberculous lymphadenitis were examined. Amongst patients with HIV-positive tuberculous lymphadenitis, lymph node enlargement was symmetrical in 29% (45/157); cervical nodes were enlarged in 99% (155/157), axillary nodes in 82% (128/ 157), epitrochlear nodes in 36% (57/157) and ilioinguinal nodes in 54% (84/157). The size of the largest nodes was 3 cm in 36% (57/157), 2 cm in 24% (37/157) and 1 cm in 6% (10/157). This presentation overlapped with that of primary HIV lymphadenopathy, which was usually a symmetrical polylymphadenopathy with nodes < or = 3 cm in size, and contrasted with that of HIV-negative tuberculous lymphadenitis, which mostly presented with focal, asymmetrical cervical lymphadenopathy. CONCLUSION: Tuberculous lymphadenitis may be more common in HIV-positive African patients with superficial lymphadenopathy than is generally believed. Greater use of lymph node aspiration or biopsy may improve the diagnosis of suspected tuberculosis in Africa.

The increased burden of tuberculous lymphadenitis in central Africa: lymph node biopsies in Lusaka, Zambia, 1981 and and 1990.

In order to assess the effect of the HIV epidemic on lymph node biopsies in Central Africa, HIV-1 serology was tested on a cohort of patients undergoing node biopsy in Lusaka in 1990, and the histology of all lymph nodes biopsied in Lusaka in 1981 and 1990 was reviewed. One hundred and eighteen lymph nodes were biopsied in 1981 and 351 in 1990. Cases of tuberculous lymphadenitis increased from 52 (31 children and 21 adults) in 1981 to 186 (22 children, 160 adults, four patients unknown age) in 1990. Sixty-eight of 77 adults (88%) with tuberculous lymphadenitis in 1990 tested HIV-positive. Cases of histology suspicious of primary HIV lymphadenopathy and nodal Kaposi's disease also increased. Cases of malignant lymphadenopathy and overall number of surgical biopsies remained equivalent for 1981 and 1990. The study concludes that the HIV epidemic has led to a large increase in diagnostic lymph node biopsies in Lusaka, mostly through an increase in HIV-related adult tuberculous lymphadenitis.

Importance of human immunodeficiency virus-associated lymphadenopathy and tuberculous lymphadenitis in patients undergoing lymph node biopsy in Zambia.

The relative importance of human immunodeficiency virus (HIV)-associated lymphadenopathy amongst patients presenting for lymph node biopsy in Central Africa is unknown. HIV-1 serology and histology of patients undergoing superficial lymph node biopsy during 1989-1990 in Lusaka, Zambia, were examined in a prospective cohort study of HIV serology and by retrospective review of laboratory records. Of 727 lymph nodes biopsied in Lusaka in 1989-1990, 380 (52 per cent) showed tuberculous lymphadenitis, 160 (22 per cent) histology suggestive of primary HIV lymphadenopathy and 66 (9 per cent) nodal Kaposi's disease. HIV serology was tested in 280 adults and was positive in 91 per cent (255 patients), including 89 per cent (153 of 171) of those with tuberculous lymphadenitis, 98 per cent (63 of 64) of those with histology suspicious of primary HIV lymphadenopathy and all (24 of 24) with nodal Kaposi's disease. Other HIV-associated lymphadenopathy included nodal lymphomas and lymphoepithelial cysts. HIV serology was tested in 22 children and was positive in eight, including four of 14 with tuberculous lymphadenitis. It is concluded that HIV-associated lymphadenopathy, especially tuberculous lymphadenitis, is very common amongst patients presenting for lymph node biopsy in Central Africa.

PIP: Data from a prospective cohort study conducted during 1989-1990 of HIV serology and from a retrospective review of laboratory records of 727 patients presenting for superficial lymph node biopsy at the University Teaching Hospital in Lusaka, Zambia, were analyzed to determine the relative significance of HIV-associated lymphadenopathy among patients undergoing lymph node biopsy. 380 (52%) of the 727 biopsy patients had tuberculous lymphadenitis (secondary HIV lymphadenopathy). Another 160 (22%) had presumed primary HIV lymphadenopathy. The remaining 66 (9%) had nodal Kaposi's disease. 280 adults were tested for HIV antibodies. 91% tested positive for HIV. The HIV rate was 89% for patients with tuberculous lymphadenitis, 98% for suspected primary HIV lymphadenopathy cases, and 100% for those with nodal Kaposi's disease. As for the 22 children 0-16 years old, 8 were HIV positive. 50% of HIV-positive children who underwent lymph node biopsy had tuberculous lymphadenitis. Three had suspected primary HIV lymphadenopathy and 1 had nodal Kaposi's disease. These findings show that HIV-associated lymphadenopathy, particularly tuberculous lymphadenitis, is very prevalent in patients undergoing lymph node biopsy. They stress the importance of investigating further HIV-positive patients with suspicious asymmetrical nodes in central Africa. Simple, appropriate methods (e.g., wide-needle aspiration) are needed for the diagnosis of tuberculous lymphadenitis in this region, with its dearth of facilities for surgery and histopathology.

The value of naked eye examination of biopsied lymph nodes in the diagnosis of tuberculous lymphadenitis.

Tuberculous lymphadenitis is common in Central Africa, where diagnosis by histological examination of a biopsied node is often delayed. In the present study, the naked eye appearance of the cut surface of 306 consecutive biopsied lymph nodes was compared with the histological diagnosis. One hundred and eight-eight nodes showed tuberculosis on histology (including two with coexisting second pathology). One hundred and forty-eight (79%) cases of tuberculous lymphadenitis (including both with coexisting second pathology) showed noncaseating tuberculomata or caseation visible on naked eye examination. Such signs were not seen in other nodes. Other signs were seen in another 18 (10%) tuberculous nodes. It is concluded that naked eye examination of nodes provides useful information for the diagnosis of tuberculous lymphadenitis, pending confirmation by histology.

Wide needle aspiration cytology in the diagnosis of lymphadenopathy in Zambia.

AIMS: To study the value of wide needle (19 gauge) aspiration cytology in the diagnosis of lymph node disease in Zambia in the absence of a trained cytologist. METHODS: Patients (n = 304) referred for surgical biopsy of an enlarged peripheral lymph node were studied prospectively. Surgical biopsy was routinely preceded by 19 gauge needle aspiration of the same node; aspirates were stained by haematoxylin and eosin and Ziehl Neelsen stains. RESULTS: Of 232 aspirates, 182 contained sufficient material for cytological characterisation. Tuberculosis was diagnosed or suspected in 122 of 126 aspirates with histologically confirmed tuberculous lymphadenitis; reactive follicular hyperplasia in 31 of 38 patients with primary HIV lymphadenopathy; malignancy in all five patients with malignant nodes; and Kaposi's disease in four of nine patients with this. Tuberculous lymphadenitis was falsely suspected in four patients, as was reactive follicular hyperplasia in four, and Kaposi's disease in four. CONCLUSIONS: Wide needle aspiration cytology is useful in the diagnosis of lymphadenopathy in Central Africa, with the exception of lymphadenopathic Kaposi's disease.

The value of wide-needle aspiration in the diagnosis of tuberculous lymphadenitis in Africa.

OBJECTIVES: To evaluate wide-needle (19-gauge) aspiration in the diagnosis of tuberculous lymphadenitis. SETTING: Department of Surgery, University Teaching Hospital, Lusaka, Zambia. PATIENTS: Three hundred and four patients presenting to one surgeon for diagnostic surgical biopsy of a peripheral lymph node during 1989-1990. DESIGN: Prospective study in which wide-needle aspiration routinely preceded open surgical biopsy. MAIN OUTCOME MEASURES: Histology and mycobacterial culture of the surgically biopsied lymph node; HIV-1 serology; successful aspiration of material, naked-eye appearance of aspirate, presence of acid-fast bacilli and/or microscopic caseation in the aspirate. RESULTS: One hundred and eighty-eight out of 304 (61.8%) patients had histologically and/or culture-proven tuberculous lymphadenitis, of whom 155 out of 183 (84.7%) tested HIV-1-seropositive. Material was successfully aspirated from 180 out of 188 (95.7%) of patients with proven tuberculous lymphadenitis. Macroscopic caseation, diagnosable on naked-eye examination alone of the aspirate, was present in 49 out of 120 (40.8%) consecutive aspirates from tuberculous nodes. Acid-fast bacilli and/or microscopic caseation were seen in 116 out of 155 (74.8%) aspirates from tuberculous nodes for which smears stained both by Ziehl-Nielsen and haematoxylin & eosin were available. CONCLUSIONS: It is recommended that all patients with suspected tuberculous lymphadenitis in Africa, undergo wide-needle aspiration before surgical biopsy or empirical treatment.

PIP: This study evaluated wide-needle (19-gauge) aspiration in the diagnosis of tuberculous lymphadenitis. 304 patients presenting to 1 surgeon for diagnostic surgical biopsy of a peripheral lymph node during 1989 and 1990 at the Department of Surgery, University Teaching Hospital, Lusaka, Zambia, were involved in this prospective study in which wide-needle aspiration routinely preceded open surgical biopsy. Histology and mycobacterial culture of the surgically biopsied lymph node, HIV-1 serology, successful aspiration of material, naked-eye appearance of aspirate, and presence of acid-fast bacilli and/or microscopic caseation in the aspirate were the main outcome measures. 188 of 304 (61.8%) patients had histologically and/or culture-proven tuberculous lymphadenitis, of whom 155 of 183 (84.7%) tested HIV-1 seropositive. Material was successfully aspirated from 190 of 188 (95.7%) patients with proven tuberculous lymphadenitis. Macroscopic caseation, diagnosable on naked-eye examination alone of the aspirate, was present in 49 of 120 (40.8%) consecutive aspirates from tuberculous nodes. Acid-fast bacilli and/or microscopic caseation were seen in 116 of 155 (74.8%) aspirates from tuberculous nodes for which smears stained by both Ziehl-Nielsen and hematoxylin and eosin were available. It is recommended that all patients with suspected tuberculous lymphadenitis in Africa undergo wide-needle aspiration before surgical biopsy or empirical treatment.

The impact of human immunodeficiency virus on presentation and diagnosis of tuberculosis in a cohort study in Zambia.

Two hundred and forty-nine patients with tuberculosis were recruited to a cohort study to investigate the interaction between tuberculosis and HIV in Lusaka, Zambia; findings at presentation are presented here. One hundred and eighty-two (73%; 95% confidence interval 67-79%) of the cases were HIV-1 antibody positive. The diagnosis of tuberculosis was confirmed by microscopy for acid-alcohol fast bacilli, culture of Mycobacterium tuberculosis, or histology in 74% of all cases. HIV negative and positive cases differed in site of disease: among HIV negative patients 72% had pulmonary disease alone, 16% extrapulmonary disease alone and 12% had both, whereas among HIV positive patients 40% had pulmonary disease alone, 34% extrapulmonary disease alone and 26% both (P < 0.001). HIV negative and positive cases were compared with regard to outcome of diagnostic procedures: 55% of HIV negative cases could be diagnosed at enrollment by sputum smear, but only 35% of HIV positive cases (P < 0.01). Among pulmonary cases confirmed by sputum culture, 76% of HIV negative patients had a positive sputum smear, compared with 57% of HIV positive patients (P = 0.09). Pleural and pericardial disease were difficult to confirm, but culture of pleural fluid was positive in 12/46 HIV positive patients, compared with 0/11 HIV negative patients. Lymph node disease was readily confirmed by biopsy. The tuberculin test was positive in only 30/110 (27%) of HIV positive cases, but in 21/38 (55%) of HIV negative cases (P < 0.01). Mycobacterium tuberculosis was cultured in 57% of HIV negative cases and 54% of HIV positive cases; no atypical mycobacteria were isolated. Initial resistance to isoniazid was present in isolates from 5% of cases with a positive culture.