What should be done in the event of simultaneous massive pulmonary embolism and myocardial infarction with ST elevation?

Massive pulmonary embolism (MPE) and acute myocardial infarction (AMI) are life-threatening conditions with well-known diagnosis and treatment. Symptoms and findings such as dyspnea, chest pain, hypotension, ECG changes and elevation of cardiac enzymes are seen in both diseases. However, MPE and AMI are rarely simultaneous in a single case. This report presents an 85-year-old patient with simultaneous MPE and AMI with ST elevation. While treatment strategies for both MPE and AMI have been adequately described, it is not clear which treatment to choose when both emergency pathologies occur simultaneously in one patient. This case report discusses the treatment of these two diseases in such a case.

QuantiFERON-TB Gold test for screening latent tuberculosis infection in hemodialysis patients.

Hemodialysis patients are at increased risk of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in hemodialysis patients. The aim of this study is to determine whether the QFT-G is more sensitive than the TST in hemodialysis patients in LTBI. Eighty nine hemodialysis patients were evaluated for latent tuberculosis infection with the TST and QFT-G. Blood was obtained for QFT-G, and then TST was administered to all patients. Demographic information, laboratory tests, chest radiography results and BCG vaccination status were collected on standardized patient medical files. Forty patients had positive QFT-G results. 56 patients had TST induration above 5 mm, 28 patients above 10 mm. 61 patients had BCG vaccination scar. Statistically significant correlation was detected between TST and QFT-G (p< 0.05). In the BCG non-vaccinated subgroup, TST was positive in 8 (29%) patients and the QFT-G was positive in 11 (39%). Among the 21 non vaccinated patients with results for both tests, the concordance between the TST and QFT-G was 82%, k= 0.61, p= 0.001. We found good agreement between the TST and QFT-G test for LTBI in non vaccinated hemodialysis patients, whereas we found poor agreement in vaccinated patients. Because BCG vaccination is widely used in our country, the QFT-G test might be more useful for the diagnosis of LTBI than TST in hemodialysis patients who are suspected to have LTBI.

Oddi sphincter fibrosis due to chemotherapy agents in small cell lung cancer: case report.

A 62-year-old, man patient was diagnosed as small cell lung cancer. Cisplatin (80 mg/m(2), first day) and etoposide (100 mg/m(2), three days) chemotherapy was started for once 21 days. As the patient received third course of chemotherapy, jaundice and hyperbilirubinemia were detected. Hepatic ultrasonography showed dilated choledochus and intrahepatic biliary tract. Hepatic markers and serologic tests for viral hepatitis were found as normal. Finally endoscopic retrograde cholangiopancreatography (ERCP) was performed. Endoscopic sphincterotomy was performed in the first ERCP and two days later, second ERCP was performed and oddi sphincter was seen as fibrotic and stenotic and stent was placed. One day after the stent placement, direct bilirubin was found as 6.2 mg/dL and 10 days later laboratory parameters were detected as normal. Oddi sphincter fibrosis occurred due to lung cancer chemotherapy treatment is an interesting case for fibrosis not having been reported due to cisplatin or etoposide before.

[The opinions of Turkish physicians about the tasks of tuberculosis central dispensary]. / Türkiye'de hekimlerin verem savas dispanseri görevleri hakkindaki bilgileri.

Department of tuberculosis control is the main tuberculosis branch of Minister of Health, with coordinators in cities as intermediate departments and Tuberculosis Central Dispensaries (TCD) as peripheral branches. This study was performed through January-May 2007 in seven different geographical regions to figure out opinions of physicians on tuberculosis dispensaries. A specific questionnaire was distributed to doctors in two cities in each geographical region. A number of 1250 doctor participated in the study as at least fifty doctors in each city. Mean age of the subjects was 32.58 +/- 6.63 (22-65), 52.1% (651) of whom had diagnosed tuberculosis before. It was found in the study that two important functions of tuberculosis central dispensaries for the doctors were the treatment of patients regularly and freely, and scanning the persons who have very close contact with active tuberculosis patient. A number of 157 doctors accepted all seven functions of dispensary as important. Female doctors, pediatricians and chest physicians had better knowledge on the tasks of tuberculosis central dispensaries (p< 0.005). This study showed that Turkish physicians did not have enough knowledge about tuberculosis and its tasks. We believe that practical training procedures for the physicians on the goals and functions of TCD will help to treat tuberculosis.