Clinical features and treatment outcomes of pulmonary actinomycosis.

OBJECTIVE: Pulmonary actinomycosis is a rare and chronic infectious disease that mimics malignancy and is frequently misdiagnosed. There are few reports that address the clinical characteristics of pulmonary actinomycosis. The objective of this research is to evaluate the clinical features, radiological findings, diagnostic approaches and treatment outcomes of pulmonary actinomycosis. PATIENTS AND METHODS: Thirty-seven patients with pulmonary actinomycosis histopathologically diagnosed from 2009 to 2021 were analyzed retrospectively. RESULTS: The mean age at presentation was 53.7 (±13.3) years. Frequent symptoms were cough and hemoptysis. The median diagnosis time from the first symptoms was 60 days (interquartile range 18-195). Pulmonary comorbidity was found in 59.5% of cases. The most common thorax computed tomography finding was mass or nodule. The low-attenuation center within the mass or consolidation was observed in 40% of the lesions. The median maximal standardized uptake value of lesions on positron emission tomography (PET) was 6.5 (interquartile range 2.7-10.3). In the majority of cases (97.3%), the diagnosis of pulmonary actinomycosis was not suspected at admission, and 56.8% of patients were misdiagnosed with lung cancer. The mean duration of antibiotic therapy was 9.4 days (range 3-22) with intravenous antibiotics and 64.7 days (range 5-270) with oral antibiotics. Four patients died due to concomitant comorbidities. Eight cases were lost to follow-up. All other cases were fully cured. CONCLUSIONS: Pulmonary actinomycosis mimics other diseases, often lung cancer. Clinicians should consider the diagnosis of actinomycosis when they detect a mass or consolidation, especially with a low-attenuation center. PET/CT appears not to be useful for differential diagnosis. A shorter course of antibiotic therapy than traditionally recommended appears to be sufficient.

Waxing and waning pulmonary nodules and myelodysplastic syndrome.

A 53-year-old diabetic woman with the diagnosis of myelodysplastic syndrome was admitted to our hospital with symptoms of anorexia, malaise, fatigue, night sweats, and weight loss. The radiological evaluation revealed waxing and waning pulmonary nodules. A diagnosis of pulmonary tuberculosis was reached by pathologic examination of a wedge biopsy. We did not find a similar case in the literature. Clinicians should keep tuberculosis in mind as a possible etiology of waxing and waning pulmonary nodules.

Effects of methylene blue, indigo carmine solution and autologous erythrocyte suspension on formation of adhesions after injection into rats.

The aim of this study was to determine whether autologous erythrocyte suspension can be used as a dye for evaluation of tubal patency and whether it has any advantages over methylene blue or indigo carmine solutions. Reproductively healthy female nulliparous Wistar Albino rats (n = 30), aged 6 months, mass 165-195 g, were assigned randomly to three groups. Rats received a 1 ml i.p. injection of 5% (w/v) methylene blue solution (methylene blue group: n = 10), 5% (w/v) indigo carmine solution (indigo carmine group: n = 10) or 5% (v/v) fresh autologous erythrocyte suspension (autologous erythrocyte group: n = 10). At 4 weeks after injection, a small sterile opening was made in the peritoneal cavity of each rat. The cavity was rinsed once with TCM-199 to collect macrophages. The rinsed peritoneal contents were cultured overnight to evaluate macrophage activation. The peritoneal opening was expanded for evaluation of adhesion formation. Only one rat from the autologous erythrocyte group had intra-peritoneal adhesions (score 2), whereas all rats in the methylene blue group (score 1: n = 1; score 2: n = 4; score 3: n = 4; and score 4: n = 1) and seven rats in the indigo carmine group (score 1: n = 1; score 2: n = 2; score 3: n = 3; and score 4: n = 1) had intra-abdominal adhesions. Macrophage activity was observed in the cultured peritoneal contents collected from the methylene blue and indigo carmine groups but not from the autologous erythrocyte group. Adhesion formation could be due to macrophage activation caused by methylene blue and indigo carmine solutions. These results indicate that tubal patency can be observed by laparoscopy using autologous erythrocyte suspension. The results of this study are believed to be the first to indicate that a patient's own erythrocyte suspension could be used during observation of tubal patency by laparoscopy. However, further studies are required.

The influence of sphincterotomy and hepatic plexus vagotomy on ascending infections of the biliary tract: an experimental study in dogs.

BACKGROUND/AIMS: Hypertonic dyskinesia of the sphincter of Oddi is an important factor in the pathogenesis of postcholecystectomy syndrome, and this condition is usually treated by endoscopic sphincterotomy. However, it has been demonstrated that the biliary tract may also be contaminated after sphincterotomy. In various experimental studies, it has been established that the choledochal pressure decreases by a mean of 32% to 28% after hepatic plexus vagotomy. This experimental study was performed to investigate whether hepatic plexus vagotomy and/or sphincterotomy result in contamination of the biliary tract. METHODOLOGY: Thirty street dogs were divided into three equal groups. The three groups underwent simple laparotomy, transduodenal papillotomy, hepatic plexus vagotomy, respectively, and gallbladder bile samples were taken from all of them. Relaparotomy was performed after four weeks, and again, bile samples were taken from the gallbladder. All bile samples were examined microbiologically. RESULTS: Bacteria were not found in the first bile samples taken from the three groups. Bacteria were not found in the bile samples taken during the second surgery in the simple laparotomy and hepatic plexus vagotomy groups. However, both aerobic and anaerobic bacteria were found in the papillotomy group in seven of the ten dogs. CONCLUSION: These results demonstrate that hepatic plexus vagotomy decreased choledochal pressure and did not cause contamination of the biliary tract. It may be a treatment of choice to prevent postcholecystectomy syndrome resulting from sphincter of Oddi dysfunction.

Possible value of nasal smear in acute maxillary sinusitis: an experimental study.

The aim of this study is to determine the role of nasal smear in evaluating diagnosis and response to the treatment by the patient of acute maxillary sinusitis. We compared nasal smear and histopathological findings obtained from rabbits experimentally induced acute maxillary sinusitis. The animals were divided into two groups; one with blocked ostium and treated with antibiotic and the other applied natural ostiotomy, during a 4-week period. There was no statistically significant difference between the two groups in respect of recovery period. This conclusion was derived from nasal smear and biopsy findings. It was observed that nasal smear and biopsy findings were consistent with each other and with clinical findings. The results of this study revealed that nasal smear may be used in the diagnosis and treatment follow-up of acute maxillary sinusitis.