Diagnosis of tuberculosis: routine cultures of bronchial washings are not indicated.

During a five-year period, cultures of bronchial washings for Mycobacterium tuberculosis were obtained almost routinely (859 of 1,012 bronchoscopic examinations.). This practice proved costly, and the diagnostic yield was extremely low. Only three cases were diagnosed solely by this method (0.35 percent). Five other cases were false-positive. Additionally, 39 patients with known active pulmonary tuberculosis had false-negative cultures of bronchial washings; 13 of these 39 patients were receiving antituberculosis drugs at the time of their bronchoscopic examinations. The inhibitory effect of local anesthetics upon the growth of M tuberculosis is the possible cause for the remaining 26 false-negative cultures. We conclude that bronchoscopic examination and culture of bronchial washings are not the best sources for diagnosis of pulmonary tuberculosis and that cultures of sputum and/or gastric washings are usually sufficient. The practice of obtaining routine cultures of bronchial washings in known pulmonary tuberculosis is of questionable value, when nearly two-thirds may be false-negative.

The significance of facial burns in acute smoke inhalation.

The medical records of 21 patients with smoke inhalation admitted to a medical ICU (MICU) were reviewed. Of 21 patients, 6 (29%) died. Of 21 patients, 13 (62%) had facial burns and 11 of the 13 (85%) later developed pneumonia. Only 1 of 8 patients (12%) without facial burns developed pneumonia (p less than 0.005). Of the 12 patients with pneumonia, 7 required ventilatory assistance and 6 of the 7 died in the MICU. The authors conclude that the presence of facial burns is associated with the later development of pneumonia in a high percentage of cases. Pneumonia contributes significantly to the high mortality rate. The need for ventilatory assistance in smoke inhalation patients is associated with a poor prognosis.

Spirometric evaluation of acute bronchial asthma.

Spirograms were obtained before and after emergency therapy in 85 episodes of acute bronchial asthma in 82 patients. The clinical status of all patients after emergency treatment was reevaluated 48 hours later. Patients could be divided into three groups: I) admissions; II) patients discharged but with later respiratory problems; and III) patients who were discharged and did well. The mean pre- and posttreatment one second forced expiratory volume (FEV1.0) was significantly different among all three groups. FEV1.0 less than or equal to 0.6 liter before treatment, or an FEV1.0 less than or equal to 1.6 liter after emergency treatment, was associated with an unfavorable course. Eighty-eight percent of Group I patients (admissions) had either an initial FEV1.0 less than or equal to 0.6 liter, or a posttreatment FEV1.0 less than or equal to 1.6 liter. Among all patients whose initail FEV1.0 was less than or equal to 0.6 liter, 80% were either admitted or had subsequent respiratory problems; 75% of all patients whose posttreatment FEV1.0 was less than or equal to 1.6 liter were either admitted or developed subsequent respiratory problems. Moreover, 90% of patients who had both a pretreatment FEV1.0 less than or equal to 0.6 liter and a posttreatment FEV1.0 less than or equal to 1.6 liter were admitted or had subsequent significant airway obstruction. We conclude that spirometry can identify asthmatic patients who require admission or who will have significant airway obstruction within 48 hours after discharge from the emergency department.