Comparison of chest CT findings between suspected and definite cases of primary pulmonary M. avium complex infection

It is very difficult to treat pulmonary infection with MAC, because we have few effective drugs against this organism. In this situation, an early diagnosis and treatment are very important to manage this disease. We evaluated chest CT scans of the primary pulmonary MAC infection which had no underlying lung diseases and no immunocompromised diseases such as HIV infection. We defined suspected cases of pulmonary MAC infection as cases in which abnormal features of chest CT scans were recognized but frequency of detection of organisms of MAC did not fulfil the diagnostic criteria for atypical mycobacteriosis according to Japanese Mycobacteriosis Research Group of the National Chest Hospitals. CT scans of suspected cases were compared with the definite cases. Results obtained were as follows: 1. In classification by CT scans of primary pulmonary MAC infection, the proportion of localized type and diffuse type was the same both in suspected and definite cases. In localized type, more tuberculosis-like pattern was seen in definite cases. 2. In suspected cases, characteristic features of CT scans of primary pulmonary MAC infection were recognized in the same frequency as in definite cases. 3. In pulmonary tuberculosis-like type, definite cases showed more cavitary lesions than suspected cases. These results showed that a careful long term follow-up of suspected cases with frequent bacteriological tests of sputum and chest CT scannings was important for early diagnosis of primary pulmonary MAC infection.     

Incidence of and Mortality from Venous Thromboembolism in a Real-world Population: The Q-VTE Study Cohort

Background

The public health burden of venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is not fully known, and contemporary incidence and mortality estimates are needed. We determined the incidence and case fatality of venous thromboembolism in a general population.

Methods

Using the administrative health care databases of the Canadian province of Québec, we identified all incident cases of deep vein thrombosis or pulmonary embolism between 2000 and 2009 and classified them as definite or probable venous thromboembolism. We formed 2 patient cohorts, one with definite cases and the other including cases with definite or probable venous thromboembolism that were followed until December 31, 2009.

Results

We identified 67,354 definite and 35,123 probable cases of venous thromboembolism. The age- and sex-adjusted incidence rates of definite or probable venous thromboembolism, deep vein thrombosis, and pulmonary embolism were 1.22 (95% confidence interval [CI], 1.22-1.23), 0.78 (95% CI, 0.77-0.79), and 0.45 (95% CI, 0.44-0.45) per 1000 person-years, respectively, while for definite venous thromboembolism it was 0.90 (95% CI, 0.89-0.90) per 1000 person-years. The 30-day and 1-year case-fatality rates after definite or probable venous thromboembolism were 10.6% (95% CI, 10.4-10.8) and 23.0% (95% CI, 22.8-23.3), respectively, and were slightly higher among definite cases. The 1-year survival rate was 0.47 (95% CI, 0.46-0.48) for cases with definite or probable venous thromboembolism and cancer, 0.93 (95% CI, 0.93-0.94) for cases with unprovoked venous thromboembolism, and 0.84 (95% CI, 0.83-0.84) for cases with venous thromboembolism secondary to a major risk factor. Similar survival rates were seen for cases with definite venous thromboembolism.

Conclusion

The risk of venous thromboembolism in the general population remains high, and mortality, especially in cancer patients with venous thromboembolism, is substantial.     

胸片正常的支气管内膜结核15例临床分析

目的 探索胸片正常的支气管内膜结核的临床特征及早期确诊手段。方法 分析15例经纤维支气管镜(纤支镜)确诊的支气管内膜结核患者的临床表现、胸部X线(平片)及CT片、纤支镜检查结果。结果 15例中主要症状包括：咳嗽15例，气促5例，胸痛4例，发热3例，咯血2例，消瘦2例。15例的X线胸片正常。纤支镜检查示46．7％的病例有炎性浸润型病变，33．3％有增殖型病变，13．3％有溃疡型病变，6．7％有狭窄闭塞型病变。15例痰涂片行抗酸染色者中3例阳性，痰培养阳性1例；纤支镜刷片检查8例阳性，活组织检查7例证实为结核。结论 支气管内膜结核无特异性临床表现及胸部X线表现正常不能排除支气管内膜结核，确诊主要依靠纤支镜检查。对不明原因发热和呼吸道症状经积极治疗无效者，应怀疑支气管内膜结核而及时行纤支镜检查。通过镜下常规刷检找抗酸杆菌配合组织活检确诊率高。     

细支气管肺泡癌75例临床分析

目的 总结经病理证实的75例细支气管肺泡癌（BAC）的临床特征和诊断方法.方法 对我院2001年1月～2010年6月收治的75例BAC进行回顾性分析.结果 75例BAC患者男女比例为1∶1.34,平均年龄56.9岁,吸烟者占12％; CT检查58例表现为孤立结节型,8例为弥漫结节型,9例为炎症浸润型;26例患者行CT或超声引导下经皮肺穿刺活检,22例获得确诊,9例行支气管镜检查,仅1例确诊,52例为手术后组织活检确诊.结论 BAC的临床特征不同于其他类型肺癌,CT检查有助于BAC的诊断,而经皮肺穿刺活检则能提高BAC诊断的正确率.     

Virus-induced vasculitis

There is a growing understanding of the different syndromes that have a definite, and in some cases a possible, association with viral infections. Hepatitis C virus-associated mixed cryoglobulinemias and hepatitis B virus-associated polyarteritis nodosa are examples of a vasculitis with a definite viral association. However, various types of cutaneous vasculitis are examples of a vasculitis with only a possible association with a viral infection.     

Cerebrospinal fluid antimicroglial antibodies in Alzheimer disease: a putative marker of an ongoing inflammatory process

Immunocompetent microglia play an important role in the pathogenesis of Alzheimer's disease (AD). Antimicroglial antibodies in the cerebrospinal fluid (CSF) in clinically diagnosed AD patients have been previously recorded. Here, we report the results of the analysis of the CSF from 38 autopsy cases: 7 with definite AD; 14 with mild and 10 with moderate Alzheimer's type pathology; and 7 controls. Antimicroglial antibodies were identified in 70% of patients with definite AD, in 80% of patients with moderate and in 28% of patients with mild Alzheimer's type pathology. CSF antimicroglial antibodies were not observed in any of the control cases. The results show that CSF antimicroglial antibodies are present in the majority of patients with definite AD and also in cases with moderate Alzheimer's type changes. They may also indicate dysregulation of microglial function. Together with previous observations, these findings indicate that compromised immune defense mechanisms play an important role in the pathogenesis of AD.     

Relationship between number of asbestos bodies in autopsy lung and pleural plaques on chest X-ray film

We investigated the relationship between number of asbestos bodies and pleural plaques. Using sodium hypochrolite, we examined 400 autopsy lungs and could detect 71 cases whose asbestos bodies were significantly high. We checked pleural plaques on chest x-ray films of these 71 cases and compared the exact plaque at autopsy. By the criteria of Askergren and Szamosi, we classified these into three groups (probable, definite, definite with calcification). This classification is consistent with the pleural plaques found at autopsy. Cases whose pleural plaques were definite (thick) had many more asbestos bodies than indefinite cases. As for occupational histories, there were 23 cases who worked in Japanese Naval shipyards before and during World War II, 14 others in various shipyards, and 14 others who also had a history of asbestos exposure. These 51 patients died more than 30 years after the first asbestos exposure. Twenty had no definite asbestos exposure.     

Comparisons between different syndromes of heart attack--a multivariate analysis

A register of acute coronary events in Auckland, New Zealand enabled characterization of cases of the following different coronary syndromes: definite myocardial infarction (MI) (divided to Type I with typical ECG findings and Type II with new symmetrical T wave inversion only), nonhypotensive definite infarction with and without ventricular fibrillation, possible myocardial infarction and sudden death. Comparisons between these syndromes were analyzed. ECG type II (as compared to ECG type I) definite infarction was a more chronic, repeated syndrome, with more myocardial fibrosis in fatal cases, and more previous prolonged anginal pain without documented infarction. Cases of possible (as compared to definite) myocardial infarction were also more likely to report previous prolonged aningal pain, to use beta blockers, furosemide and less likely to die within 30 days. They consumed significantly more alcohol and were more likely to be female, than cases of definite infarction. Patients with nonhypotensive definite infarction complicated by ventricular fibrillation had higher acute phase pulse rates and more pallor and sweating than similar patients not experiencing ventricular fibrillation. Some possible explanations for the above findings were discussed.     

HCV infection and its clinical features in recipients of blood screened for HCV (C100-3) antibody

Abstract After adoption of the anti-hepatitis C virus (C100-3) test, the incidences of definite and suspected cases of post-transfusional hepatitis (PTH) were 3.3% (7/209) and 7.2% (15/209), respectively. Four patients with definite PTH and seven patients with suspected PTH became positive for hepatitis C virus (HCV)-related antibodies or HCV-RNA after transfusion. These cases that became positive for anti-HCV or HCV-RNA showed a peak of alanine aminotransferase (ALT) more than 4 weeks after operation. Only rare cases that showed ALT peaks within 4 weeks after operation became positive for HCV-related antibodies or HCV-RNA. The peak ALT levels in cases showing positive conversion tended to be higher than those in cases showing no conversion. Judging from these results, cases of suspected PTH include those of transient liver disease attributable to surgery as well as clear cases of HCV infection. Thus new diagnostic criteria are required including data on HCV antibodies or HCV-RNA.     

支气管内膜结核90例临床分析

目的探索支气管内膜结核（ＥＢＴＢ）的临床特征及早期确诊手段。方法分析９０例经纤维支气管镜（纤支镜）确诊的ＥＢＴＢ患者的临床表现、胸部Ｘ线（ＣＴ）、纤支镜检查结果。结果９０例中主要症状包括：咳嗽７５例,发热２７例,咯血２４例,胸痛１８例,气促１１例,消瘦７例。气道阻塞症状少,仅２例出现喘息。７例的Ｘ线表现正常,只有２例的ＣＴ检查结果提示ＥＢＴＢ。纤支镜检查示３８％的病例有炎症浸润型病变,９％有增殖型病变,２６％有狭窄闭塞型病变,１７％有溃疡型病变,１１％大致正常。５６例痰涂片行抗酸染色者中８例阳性,８６例行纤支镜刷片检查者中７３例阳性,５６例行活组织检查者中１７例证实为结核。结论ＥＢＴＢ缺乏特异性临床表现,胸部Ｘ线表现正常不能排除ＥＢＴＢ,ＣＴ诊断价值不高,确诊主要依靠纤支镜检查。对不明原因低热和呼吸道症状经积极治疗无效者,应怀疑ＥＢＴＢ而及时行纤支镜检查。行镜下常规刷检找抗酸杆菌和（或）组织活检阳性率高,且简便快捷,值得推广。     

Postoperative histological diagnosis in two cases of unsuspected bioprosthetic endocarditis

Two cases of preoperatively unsuspected porcine bioprosthetic endocarditis are presented. Both cases, thought to be a sterile thrombosis and a primary tissue failure respectively, were correctly diagnosed only with histological examination. Cultures and histological examination of the explanted tissue are necessary for a definite diagnosis in every case of prosthetic malfunction.     

Alteration in P-R interval associated with change in posture

Out of twenty cases with prolonged P-R interval four cases are reported in which definite reduction in the P-R interval occurred on change from the recumbent to the upright position. Similar effects were noted with change in posture and respiration in the electrocardiogram of one man from a group of thirty whose P-R intervals were within the normal limits.     

The status of the heart in myxedema

This study is based upon an analysis of the hospital records of eighteen cases of definite myxedema with an average basal metabolic rate on admission of minus 33 per cent. The average age of these patients was forty-seven years. Seven of these patients showed evidence of cardiac insufficiency; nine had enlargement of the heart; seven had hypertension; and in seven a definite generalized arteriosclerosis was noted. There did not appear to be any definite relation between the presence of hypertension or arteriosclerosis and the duration of the myxedematous state. The symptoms and signs of cardiac weakness disappeared under thyroid medication. In all cases, the electrocardiogram showed P-waves and QRS-waves of relatively small amplitude. The most striking abnormality was the flattening or inversion of the T-deflection which disappeared after treatment in the seven cases in which the electrocardiographic examination was repeated after the basal metabolic rate had returned to normal.     

Nosocomial legionnaires' disease: lessons from a four-year prospective study

We studied all cases of nosocomial pneumonia at our 800-bed tertiary care hospital from September 1983 to September 1987. Of the 813 cases of nosocomial pneumonia, 31 (3.8%) were definite (isolation of organism or fourfold rise in titer) and 21 (2.5%) were possible cases (single or stable antibody titer of greater than or equal to 1:256) of legionnaires' disease. The definite cases involved a more severe form of pneumonia and a significantly higher mortality rate--64% versus 14% (p less than 0.0009) compared with the possible cases. Despite attempted comprehensive surveillance, only four (13%) of the definite cases of legionnaires' disease were found that would not have been diagnosed if the study were not ongoing. The yield from adequate (4- to 6-week convalescent serum samples) serologic testing was 5%, whereas the yield from sputum culture was 11%. We conclude that targeted surveillance of immunosuppressed patients with nosocomial pneumonia by culture of respiratory tract secretions for Legionella pneumophila is adequate for monitoring for the presence of legionnaires' disease in a hospital.     

结核病分子病理学诊断技术临床应用进展

病理学是诊断结核病的重要途径,尤其在痰菌阴性的肺结核及肺外结核等疑难患者的诊断中发挥了重要作用。2017年公布的《中国结核病病理学诊断专家共识》提出病理学确诊结核病必须同时满足两个条件:(1)组织形态学符合结核病病理基本变化;(2)通过分子病理学检测获得明确的病原学依据。近年来,分子病理学诊断技术在结核病的诊断和鉴别诊断中起到越来越重要的作用。作者对分子病理学技术在诊断结核病、非结核分枝杆菌病,以及耐药结核病中的应用进展进行了综述。     

The diagnosis of definitive or probable tuberculosis and latent tuberculosis infection in children with suspected tuberculosis

Pulmonary tuberculosis (Tbc) continues to be an important cause of morbidity in children in our country and in the world. There are diagnostic difficulties in the evaluation of the patients with suspected Tbc. In our study of 118 cases, the signs or symptoms suggestive of pulmonary Tbc have a microbiologically confirmed ratio of 26% within the cases having a positive tuberculin test result or having a contact with an adult that had Tbc. Thirty-one (26%) patients were diagnosed with definite Tbc, 48 (41%) patients with probable Tbc and 28 (24%) patients with latent Tbc infection. The tuberculin test was positive in 22 (71%) patients with definite Tbc and in 29 (60%) patients with probable Tbc. A history of a contact with an adult having Tbc has been observed in 18 (58%) patients in definite Tbc case group, in 23 (48%) patients in probable Tbc case group and in 13 (46%) patients in latent Tbc infection case group. No significant difference has been observed between patients with definite or probable pulmonary Tbc according to the average age, sex, tuberculin test positivity and history of Tbc contact. The most common clinical symptoms that has been observed in both groups were cough, fever and weight loss and the most common radiological finding that has been found in both groups was persistent infiltration. Definite or probable Tbc cases were treated for a period of 6 months with 3 anti-Tbc drugs. There were no patients who had failed to response to the treatment. These results showed that, the diagnostic criteria used for probable pulmonary Tbc are also useful in detecting the patients who should be treated with anti-Tbc drugs.     

Prevalence of chronic pancreatitis: Results of a primary care physician-based population study

BackgroundData on chronic pancreatitis prevalence are scanty and usually limited to hospital-based studies.AimInvestigating chronic pancreatitis prevalence in primary care.MethodsParticipating primary care physicians reported the prevalence of chronic pancreatitis among their registered patients, environmental factors and disease characteristics. The data were centrally reviewed and chronic pancreatitis cases defined according to M-ANNHEIM criteria for diagnosis and severity and TIGAR-O classification for etiology.ResultsTwenty-three primary care physicians participated in the study. According to their judgment, 51 of 36.401 patients had chronic pancreatitis. After reviewing each patient data, 11 turned out to have definite, 5 probable, 19 borderline and 16 uncertain disease. Prevalence was 30.2/100.000 for definite cases and 44.0/100.000 for definite plus probable cases. Of the 16 patients with definite/probable diagnosis, 8 were male, with mean age of 55.6 (±16.7). Four patients had alcoholic etiology, 5 post-acute/recurrent pancreatitis, 6 were deemed to be idiopathic. Four had pancreatic exocrine insufficiency, 10 were receiving pancreatic enzymes, and six had pain. Most patients had initial stage and non-severe disease.ConclusionsThis is the first study investigating the prevalence of chronic pancreatitis in primary care. Results suggest that the prevalence in this context is higher than in hospital-based studies, with specific features, possibly representing an earlier disease stage.     

Do discharge codes underestimate hospitalisation due to heart failure? Validation study of hospital discharge coding for heart failure

BACKGROUND: Discharge codes are frequently used to describe hospital activity related to heart failure (HF). OBJECTIVES: To determine whether discharge codes for HF underestimated or overestimated hospital activity related to HF. DESIGN: Patients with atrial fibrillation (AF), who commonly have HF, were identified and their case notes reviewed to identify cases of HF missed by discharge codes. PARTICIPANTS AND METHODS: Patients admitted between November 1997 and January 1998 with either HF or AF. Identification of HF and AF by ICD10 hospital discharge codes. Identification of additional cases of AF from a central hospital-wide ECG database. RESULTS: We identified 330 cases with an ICD 10 code for HF, of which 43 (13%) were deemed to be miscoded, 32 patients (10%) were classified as possible, 39 (12%) as probable and 216 (65%) as definite HF. Results were similar whether or not HF was the primary discharge diagnosis. We identified 452 patients with AF, of whom 45 (10%) were classified as probable and 193 (43%) as definite HF. 129 (54%) of these cases had no diagnostic discharge code for HF. ICD 10 discharge codes for HF were correct in 77% of cases but identified only 66% of patients with probable or definite HF in this analysis. Screening of other diagnoses would have identified further cases of HF. CONCLUSIONS: Hospital discharge codes substantially underestimate hospital events related to HF in the UK.     

Frequency of systemic lupus erythematosus in different ethnic groups in Hawaii.

A survey of systemic lupus erythematosus (SLE) patients was conducted in civilian general hospitals on Oahu, Hawaii for the years 1970-75. One hundred sixty-eight cases were ascertained, of which 107 were considered "definite." Age-adjusted prevalence rates per 100,000 were estimated for definite cases at the end of 1975 as follows: white 5.8, Chinese 24.1, Filipino 19.9, part-Hawaiian 20.4, and Japanese 18.2. There was a heavy preponderance of females in each ethnic group, averaging 90% of the definite cases overall. Review of vital statistics for the United States and Hawaii during this period showed age-adjusted SLE mortality rates per million as follows: U.S. white 3.04, U.S. non-white 8.82, Hawaii white 1.89, Hawaii non-white 14.46. The cause of the very high SLE prevalence and mortality in the Oriental and Polynesian people of Hawaii is not clear.