Investigation of Helicobacter pylori in bronchoscopic lung specimens of young male patients with bronchiectasis but without gastrointestinal symptoms.

Anti-Helicobacter pylori IgG serum levels were measured in 31 young male bronchiectasis patients without gastrointestinal symptoms, and 56 healthy males. The possible presence of H. pylori was also investigated by rapid urease tests, culture and histopathological examination of protected catheter brush and biopsy specimens from the bronchiectatic site. No serological, microbiological or histological evidence of H. pylori infection was found in the bronchiectasis patient group. H. pylori did not appear to be an agent of infection or chronic colonisation in bronchiectasis, and may not have a significant role in the progression of this disease.

The value of pleural fluid anti-A60 IgM in BCG-vaccinated tuberculous pleurisy patients.

OBJECTIVES: To determine if detection of IgM and IgG antibodies against mycobacterial antigen A60, together with the Mantoux tuberculin skin test (TST), could be used in the diagnosis of tuberculous pleurisy (TP) in BCG-vaccinated cases. METHODS: We investigated 125 BCG-vaccinated patients with pleural effusion. Of these, 88 had TP and 37 had non-tuberculous pleurisy (NTP). TST and anti-A60 IgM and IgG measurements by ELISA were performed in the sera and pleural effusions of both groups. RESULTS: Cut-off values, in optical density, for serum anti-A60 IgM, pleural fluid anti-A60 IgM, serum anti-A60 IgG and pleural fluid anti-A60 IgG were defined as 0.624, 0.614, 0.464, and 0.613, respectively. TP patients had higher IgG and IgM levels in the serum (P < 0.001 and P < 0.05, respectively) and pleural effusion (P < 0.001 and P < 0.001, respectively). Regardless of the diagnosis, IgG and IgM levels were higher in the sera (P < 0.001 and P < 0.05, respectively) and pleural effusions (P < 0.001 and P < 0.001, respectively) of TST-positive cases, and serum and pleural fluid IgM levels were higher (P < 0.001 and P < 0.001, respectively) in the TST-positive TP cases. Sensitivity and specificity of TST were 65% and 68%, respectively. As a single parameter, pleural fluid anti-A60 IgM had the highest sensitivity (77%) and specificity (94%) in patients with negative TST. CONCLUSION: We suggest that in populations where tuberculosis prevalence is high and BCG vaccination is common, pleural fluid anti-A60 IgM can facilitate the diagnosis of TP.

The effect of pleural fluid content on the development of pleural thickness.

SETTING: Residual pleural thickness (RPT) is a common complication of tuberculous pleurisy (TP), and the degree of RPT cannot be predicted in advance. OBJECTIVES: To determine whether pleural fluid content has an effect on the development of RPT. DESIGN: Forty-seven patients with TP were enrolled in the study. A set of biochemical tests: lactate dehydrogenase, glucose, total proteins, adenosine deaminase, tumour necrosis factor alpha (TNF-alpha), alpha-1 acid glycoprotein (AAG), alpha-2 macroglobulin, C-reactive protein (CRP), complement 3 and complement 4 were studied in the pleural fluid samples. After 6 months of anti-tuberculosis treatment, patients were re-evaluated for RPT. RPT was defined in a posteroanterior chest radiograph as a pleural space of >2 mm or >10 mm measured in the lower lateral chest at the level of an imaginary horizontal line intersecting the diaphragmatic dome. RESULTS: Seventeen patients (36.17%) had an RPT of <2 mm, 18 (38.29%) had an RPT of 2-10 mm, and 12 (25.53%) had an RPT of >10 mm. TNF-alpha levels were lower in patients with an RPT of <2 mm than in patients with an RPT of 2-10 mm or >10 mm (P < 0.05 and P < 0.01, respectively). The level of TNF-alpha was higher in patients with an RPT of >10 mm compared to the 2-10 mm group (P < 0.05). Meanwhile, pleural fluid glucose, AAG and CRP concentrations were significantly higher in patients with an RPT of >10 mm than in patients with <2 mm RPT (P < 0.05, P < 0.01, and P < 0.05, respectively). CONCLUSION: In TP, the development and degree of RPT are significantly correlated to the glucose, CRP, AAG, and TNF-alpha levels in the pleural fluid.

Hemostatic changes in active pulmonary tuberculosis.

OBJECTIVE: Severe pulmonary tuberculosis (PTB) is sometimes complicated by deep vein thrombosis (DVT). We have searched for possible hemostatic disturbances that are predisposing factors for venous thrombosis in patients with PTB. DESIGN: Coagulation and platelet function tests were studied in 45 patients with active PTB and 20 healthy control volunteers before therapy. Findings were compared with results at 30 days. RESULTS: Analysis in patients with active PTB showed anemia, leucocytosis, thrombocytosis, elevation in plasma fibrinogen, factor VIII, plasminogen activator inhibitor 1 (PAI-1) with depressed antithrombin III (AT III) and protein C (PC) levels. On the 30th day of treatment, anemia, leucocytosis and thrombocytosis were improved. Fibrinogen and factor VIII levels had decreased to normal levels, PC and AT III levels had increased to normal levels, and there was no difference in PAI-1 levels. We found no activated protein C resistance. Platelet aggregation studies demonstrated increased platelet activation. However, DVT was not detected in patients during the follow-up period. CONCLUSION: Decreased AT III, PC and elevated plasma fibrinogen levels and increased platelet aggregation appear to induce a hypercoagulable state seen in PTB and improve with treatment.

Clinical experience of surgical therapy in 207 patients with thoracic hydatidosis over a 12-year-period.

PRINCIPLES: Hydatid disease is the most severe helminthic zoonosis, with a major medical, social, and economic impact in Turkey. The aim of this study was to evaluate retrospectively 207 patients diagnosed with hydatid cyst and treated surgically in our department between January 1990 and December 2001. METHODS: Hundred and ninety three patients were male and 14 female. They ranged in age from 19 to 72 years (mean 25.3 years). The most common presenting symptoms were cough, expectoration and chest pain. The surgical approach was thoracotomy in 198 patients, bilateral staged thoracotomies in 5 patients, median sternotomy in one patient and video-assisted thoracic surgery in 3 patients. RESULTS: Hundred and thirty eight of the 265 intrapulmonary cystic lesions were found in the right lung and 127 in the left lung. Intrathoracic extrapulmonary cystic lesions were detected in 13 patients. 38 patients also had cystic lesions in the liver. Conservative surgical procedures were adopted except for small wedge resections in 8 patients, segmentectomy in 4 patients and lobectomy in one. Operative and postoperative mortality was nil. Albendazole treatment was given to patients who had multiple intrathoracic cysts or additional hepatic cysts after 1994. CONCLUSIONS: Our preferred surgical techniques for removal of cysts were conservative surgical procedures such as enucleation of cysts or removal by cystotomy. Radical procedures such as pneumonectomy, lobectomy and segmentectomy should be avoided as far as possible.

Prevalence and prognostic value of c-erbB2 expression in non-small cell lung cancer (NSCLC).

The c-erbB2 oncoprotein is highly expressed in approximately one third of non-small cell lung cancer (NSCLC) patients. We determined the status of c-erbB2 expression in our patients with NSCLC and investigated its correlation with disease stage, histological type and response to treatment. Eighty-four patients were examined for the expression of c-erbB2 by immunohistochemistry using a polyclonal antibody. The scoring criteria of Clinical Trial Assay (CTA) were used to evaluate staining (0 to +3). c-erbB2 overexpression was determined in 35% of the cases. Tumors from higher stage disease (stage IIIb-IV) were more often c-erbB2 positive in adenocarcinoma (ADC) (p=0.04). In addition, there was an association between c-erbB2 score and disease stage in ADC patients (p=0.03). Our study did not demonstrate an association of c-erbB2 overexpression with response to chemotherapy. We conclude that c-erbB2 overexpression may be a prognostic marker for evaluating tumor progression in NSCLC patients but further studies must be performed with larger patient populations.

Can't lung cancer patients detoxify procarcinogens?

BACKGROUND: Glutathione S-transferase mu (GST mu) enzyme detoxifies carcinogens in tobacco smoke. We assessed the clinical usefulness of serum assay of GSTm in determining the risk for lung cancer. MATERIALS AND METHODS: Fifty-nine patients with primary lung cancer and 32 control cases were enrolled. GSTm detection was performed by the method ELISA. RESULTS: GSTm enzyme positivity rate of the patient group (39%) was significantly lower than the control group (59.4%) (p < 0.05). The GSTm positivity rates were 28.6% for the non-smoker patients with a cancer history of relatives, 31.6% for the smoker patients with the cancer history of relatives, 14.6% for the non-smoker patients with the lung cancer history of relatives and 16.7% for the smoker patients with the lung cancer history of relatives. CONCLUSIONS: We concluded that if the people lacking GSTm are smokers and have a cancer and/or lung cancer history among their relatives, they would challenge a greater risk of lung cancer than the individuals having GST mu isoenzyme.

Pyo-pneumothorax in patients with active pulmonary tuberculosis: an analysis of 17 cases without intrapleural fibrinolytic treatment.

OBJECTIVE: To review the medical records of patients with active pulmonary tuberculosis (TB) and pyo-pneumothorax (PPT). SUBJECTS AND METHODS: Medical records of 17 patients (14 male, 3 female, mean age 23.8 years, range 20-52) with PPT and active pulmonary tuberculosis at Gulhane Military Medical Academia Haydarpasa Training Hospital, Istanbul, Turkey, were reviewed from January 1998 to December 2002. The patients were treated with chest tube drainage and chemotherapy. Intrapleural fibrinolytic agents or irrigation was not performed. RESULTS: Pleural fluid samples were available in 14 patients and the mean levels of LDH, protein and glucose in the pleural fluid were 1,767 +/- 944 U/l, 5.2 +/- 1.4 g/dl and 31.7 +/- 22.6 mg/dl, respectively. Mycobacterium tuberculosis was detected in the pleural effusion of 3 patients. The duration of chest tube drainage was longer in cases who underwent open drainage (p = 0.014). At the end of the treatment period 10 patients developed pleural thickening, 4 of them underwent decortication and pneumonectomy was also done in 1 patient. The development of pleural thickening was related to the level of pleural fluid glucose (p = 0.04). CONCLUSION: This study shows that while taking care of patients with pulmonary TB the physician must be aware of the complication of PPT and that adequate chemotherapy and drainage must be duly performed.

[Sensitivity of mastitis pathogens to antibiotics and chemotherapeutic agents]. / Zur Antibiotika- und Chemotherapeutikaempfindlichkeit von Mastitiserregern

Sensitivity of mastitis bacteria to antibiotics and chemotherapeutic agents. The author tested the following bacteria, isolated from milk: -2236 strains of streptococci (1384 of group B, 262 of group C, 62 of group D, 109 of E, 16 of F, 24 of G, 7 of H, 11 of K, 270 of L, 5 of M, 41 of N, 45 of P); 361 ungroupable streptococci; 18,481 CAMP-positve, 1,966 CAMP-negative beta-haemolytic streptococci; 5,403 CAMP-negative, non-haemolytic streptococci; 1,179 strains of staphylococci, 596 of coliforms, 477 Corynebacterium pyogenes. They were tested against penicillin, streptomycin, chloramphenicol, oxytetracycline, and some were also tested against Nifuzin, Suprazid and sulfadimidine. A high proportion of the streptococci, which were the dominant mastitis agents, was sensitive to penicillin: - 97.2% of group B, 99.2% of C, 96.3% of E, 99.6% of L, 98.7% of CAMP-positive strains, 99.6% of beta-haemolytic strains. Only 20 strains of streptococci (0.08%) were resistent to penicillin. More than half were resistent to streptomycin (52.19%) while 44.38% showed decreased sensitivity. Nearly all streptococci (98.53%) were susceptible to chloramphenicol. With oxytetracycline most CAMP-positive (96.4%) and group B streptococci (95.4%) were sensitive, but only 53.4% of groups C, G and L and 31.4% of beta-haemolytic streptococci were. Sensitivity to Nifuzin, Suprazid and sulfadimidine was variable: the proportion of streptococci sensitive to each drug was 75.32%, 58.51% and 66.05%. During the ten year period of testing (1963 to 1972) the only evidence of an increase in resistance was with oxytetracycline, involving streptococci of groups N and P, the ungroupable strains and above all the beta-haemolytic strains. 82% of the staphylococci were sensitive to penicillin, 89.6% to streptomycin, 95.5% to chloramphenicol and 96.2% to oxytetracycline. Between 1963/66 and 1972 the proportion of strains showing reduced sensitivity to penicillin rose by 28.1%. With sulphonamides, 80.4% were sensitive to Suprazid and 80.6% to sulfadimidine, showing that these drugs were less effective in vitro than antibiotics. 92% of staphylococcal strains were sensitive to Nifuzin. Among coliform bacteria the dominant pattern was sensitivity to streptomycin (96%-, chloramphenicol (97.3%), oxytetracycline (88%), Nifuzin (95%), Suprazid (92%) and sulfadimidine (91.3%). The only change between 1963 and 1972 was a 14% increase in strains resistant to oxytetracacline. Strains of Corynebacterium pyogenes were generally sensitive to penicillin (100%), chloramphenicol (100%) and oxytetracycline (99%); the proportion sensitive to streptomycin was 88%, to Nifuzin 84.8%, and to sulfadimidine only 36%. There was no change in the sensitivity pattern between 1963 and 1972.

[R and S-streptococcal infections in swine]. / R- und S-Streptokokken-Infektionen beim Schwein

Some 115 R- and 143 S-streptococcal strains were isolated from 258 pigs that had died or been killed for disease, between 1969 and 1973. They were cultured and biochemically tested for sensitivity to chemotherapeutics. All R- and S-strains were of normal sensitivity to penicillin and, with few exceptions, to chloramphenicol and oxytetracycline as well. Most of the strains caused primary Sc.-infection, such as septicaemia, leptomeningitis, endocarditis, and arthritis. R-Sc.-infections were contracted mainly by store pigs and animals in advenced age, while S-Sc.-infections affected mainly piglets.

[Staphylococcus aureus infection in chickens in industrialized poultry units. 2. Microbiological studies: Staphylococcus aureus and other pathogens]. / Untersuchungen zur Staphylococcus-aureus-Infektion des Huhnes in Anlagen der industriemässigen Geflügelproduktion. 2. Mitteilung: Mikrobiologische Untersuchungen: Staphylococcus aureus und andere Erreger.

Checks were applied to 3,213 dead or ill broiler chickens and broiler parents for the purpose of elucidating enzootic or epizootic Staphylococcus aureus infections which had occurred on three industrialised poultry units. Rates of Staphylococcus aureus detection and identification declined by the following order: staphylococcal septicaemia (100 per cent), dermatitis (75.42 per cent), arthritis and tenosynovitis or osteomyelitis (64.59 per cent), wound infections (24.02 per cent), infection of bursa suprasternalis (18.94 per cent), underdevelopment (8.70 per cent), navel-yolksac-peritonitis (7.83 per cent), and conjunctivitis (7.14 per cent). Staphylococcus aureus was found to be the most important pathogen of arthritis with synovitis and of osteomyelitis with epiphysiolysis, the rate of detection being directly correlated with the severity of the pathologico-anatomic alterations established. Attempts to culture mycoplasmas from irritated synovial sheaths were successful only in three of 56 examined animals (5.3 per cent). The site variety of gallinae or strains of the crystal-violet Type A with lysis patterns of 84, 53, 77 and 84 accounted for 78.1 per cent of all Staphylococcus aureus strains isolated from infected fowl. Their percentual importance was 85.0 for septicaemia, dermatitis, and arthritis with synovitis and osteomyelitis. For prophylaxis and control of Staphylococcus aureus infections of fowl on elimination of predisposing factors and on the control of epidemic occurrence of the above types.

[Type 2 Streptococcus suis (R-Streptococci) as pathogens of occupational diseases. Report of a case and a review of the literature]. / Streptococcus suis Typ 2 (R-Streptokokken) als Erreger von Berufskrankheiten. Bericht über eine Erkrankung und Literaturübersicht.

Report on the second human case of a Streptococcus suis type 2 (group R streptococci) infection in the GDR. The patient, a 33-year-old butcher, fell ill with an acute meningitis and an initial myocarditis. Group R streptococci were isolated from cerebrospinal fluid and blood. The patient was treated with penicillin G, ampicillin and gentamicin, followed by trimethoprim-sulfamerazine. Both, meningitis and myocarditis disappeared and the patient recovered completely. The disease was recognized as an occupational disease. Review of the literature. Since 1968 108 cases of human S.suis type 2 infections were described, mostly as meningitis. In most of the cases a close contact to pigs could be confirmed.