An Occupational Hazard for Pathologists and Pathology Technicians in Japan

The incidence of pulmonary tuberculosis among pathology workers in Japan is elevated, presumably due to frequent exposure to tubercle bacilli in the work place. To demonstrate the etiological significance of the association between this disease and occupation epidemiologically, a questionnaire survey was performed to assess the incidence of pulmonary tuberculosis among 1,201 pathologists and 1,187 pathology technicians throughout Japan. Pathology department workers other than pathologists and technicians, such as secretaries (n = 207), and workers in university departments of preventive medicine and public health (n = 732) served as control groups. While non-occupation-related tuberculosis was found in both departmental groups with nearly equal incidence, the incidence of pulmonary tuberculosis among pathologists and pathology technicians after engagement in their current specialist work was significantly higher than that in the control groups (odds ratio = 6.08–10.98). The incidence of disease among pathology technicians who assisted in autopsies was markedly higher than among those not involved in autopsies (odds ratio = 6.65). This elevated incidence was significantly related to the duration of work in pathology activities, and showed little change over the last decade. These findings indicate that specific environmental conditions in pathology departments, particularly autopsy of cadavers harboring active tuberculosis, constitute a serious occupational hazard. Acta Pathol Jpn 40: 116–127, 1990.     

脊柱结核与脊柱转移瘤的MRI表现差异探讨

目的 探讨脊柱结核与脊柱转移瘤的MRI形态及信号差异。方法 回顾性分析35例脊柱结核与68例脊柱转移瘤的MRI表现。结果 脊柱结核多发生于椎体前半部，以相邻多发和弥散形式出现，转移瘤多以单发形式出现，多发生于椎体中后部及附件，多发时多呈跳跃式分布。结核常累及椎间盘，而转移瘤较少累及椎间盘。结核椎体外肿块呈长条梭形，多呈周边强化或无强化。转移瘤的椎体外肿块呈半圆形，多为均匀强化，周边强化少见。结核多呈不规则长T2高信号，骨皮质破坏一般较小，低信号骨皮质向外移位较少，而转移瘤的骨皮质则多呈较多点状虫蚀状破坏，骨皮质多有向外移位征象，信号相对较均匀。结论 根据病变的信号特点及椎体骨皮质破坏情况及椎旁组织形态及信号差异，椎间盘破坏情况可较明确做出两者的鉴别诊断。     

Acute effect of low-flux hemodialysis process on the results of the interferon-gamma-based QuantiFERON-TB Gold In-Tube test in end-stage renal disease patients

Abstract: Background. Screening for latent tuberculosis infection before solid organ transplantation is mandatory, but this is not so easy in uremic patients on hemodialysis (HD) treatment. The newly developed interferon-gamma (IFN-γ)-based QuantiFERON^®–TB Gold In-Tube test (QFT-G) seems to be superior to the other available tests.
Objective. To investigate the acute effect of the low-flux HD process on the results of the QFT-G assay.
Methods. A total of 56 HD patients participated in this prospective study. They were dialyzed under low-flux HD for at least 1 month before blood sampling for QFT-G assay. This assay was performed before and after the 4-h low-flux HD session.
Results. Compared with the pre-dialysis level, there was an obvious reduction in the IFN-γ production level (in response to the TB-antigen cocktails) after the HD process ( P =0.00). The pre-dialysis test result was negative in 21 (37.5%), positive in 33 (58.9%), and indeterminate in 2 (3.6%) patients. One pre-dialysis negative result changed to positive after the HD process. On the other hand, 7 pre-dialysis positive and 2 indeterminate results become negative after HD ( P =0.012).
Conclusion. In order to maintain the sensitivity of QFT-G assay in chronic renal failure patients on low-flux HD treatment, it is better to perform the test immediately before (not after) the HD process.     

不同类型结核病患者血清溶菌酶含量观察与诊断价值

本文对311例结核病和l0o例豫北地区正常人血清溶菌酶(SLZM)含量进行了检测。活动型肺结核中Ⅲ、Ⅳ、Ⅴ型、恢复期肺结核、脊椎结核、结核性脑膜炎和其它结核 SLZM 含量与豫北地区正常人相比均有极显著性差异(P<0.01)。其中恢复期肺结核、活动型肺结核Ⅲ、Ⅳ和Ⅴ型 SLZM 含量经统计学分析四者之间有极显著性差异(P<0.01)。因此 SLZM 含量检测可作为结核病特别是肺结核的诊断、辅助分型和治疗观察的指标之一。     

Interventional Bronchoscopy for the Treatment of Tracheal and Bronchial Tuberculosis

Objective To investigate the efficacy of interventional bronchoscopy in treatment of tracheal and bronchial tuberculosis. Methods 76 patients who were diagnosed as tracheobronchial tuberchlosis by bronchoscopic biopsy or/and sputum smear were analyzed, and different bronchoscopic therapies included bronchoscopic local injection, microwave coagulation, laser therapy and balloon dilatation were used respectively, besides conventional chemotherapy. Results The effects were classified into three groups： complete response was in 47 cases （61.8%）; partly response in 25 cases （32.9%）; no effectiveness in 4 cases. Conclusion The interventional bronchoscopy is a safe and efficacious method for endobronchial tuberculosis.     

Nontuberculous Mycobacteria�Cassociated Lung Disease in Hospitalized Persons, United States, 1998�C2005

The prevalence and trends of pulmonary nontuberculous mycobacteria (NTM)–associated hospitalizations in the United States were estimated using national hospital discharge data. Records were extracted for all persons with a pulmonary NTM International Classification of Diseases code (031.0) hospitalized in the 11 states with continuous data available from 1998 through 2005. Prevalence was calculated using US census data. Pulmonary NTM hospitalizations (031.0) increased significantly with age among both sexes: relative prevalence for persons 70–79 years of age compared with those 40–49 years of age was 15/100,000 for women (9.4 vs. 0.6) and 9/100,000 for men (7.6 vs. 0.83). Annual prevalence increased significantly among men and women in Florida (3.2%/year and 6.5%/year, respectively) and among women in New York (4.6%/year) with no significant changes in California. The prevalence of pulmonary NTM–associated hospitalizations is increasing in selected geographic areas of the United States.     

PAPILLARY NECROSIS ASSOCIATED WITH RIFAMPICIN THERAPY

We report a patient who developed progressive renal failure following 13 months of rifampicin therapy for renal tuberculosis. The renal function continued to deteriorate despite the discontinuation of rifampicin. Renal pathology did not demonstrate any evidence of tuberculosis of the kidney but revealed the unique pathological finding of glomeruloscterosis, granulomatous interstitial nephritis, and extensive papillary necrosis.     

COL1A1 Sp1-binding site polymorphism as a risk factor for genital prolapse

The objective of this study was to verify the possible association between the Sp1-binding site polymorphism and genital prolapse. A case–control study was conducted in 107 patients with stages III and IV genital prolapse. The control group included 209 women with stages 0 and I. The polymorphism of type I collagen Sp1-binding site was identified by amplification of the first intron of the COL1A1 gene. We did not find differences in the prevalence of the GT and TT genotypes between the groups (p = 0.34), even when we grouped patients with at least one polymorphic allele (GT and TT) and compared them with patients without the polymorphic allele (GG; p = 0.17) The presence of at least one vaginal delivery, family history for prolapse, and macrosomatic fetus were independent risk factors for prolapse. In conclusion, the COL1A1 Sp1-binding site was not significantly associated with genital prolapse among our study subjects.     

老年人肺结核误诊为支气管肺癌原因分析

目的：了解老年人肺结核误诊为支气管肺癌的原因，找出准确、迅速诊断老年人肺结核的方法。方法：对我院近３ａ来收治的８例老年肺结核误诊为支气管肺癌患者的临床资料进行分析。结果：Ｘ线表现：３例为团块状阴影，均伴阻塞性肺不张，另５例表现为肺膨胀不全。纤维支气管镜检查：镜下可见不同部位支气管粘膜肿物，局部粘膜肿胀、狭窄，表面凸凹不平或被坏死组织覆盖。结论：经纤维支气管镜检查病变部位活组织，是迅速、准确诊断老年肺结核的可靠方法     

Tuberculosis isolated to the renal allograft

Immunosuppressed patients after renal transplantation are at increased risk of developing infective complications, including tuberculosis. We describe four renal transplant patients who presented with tuberculosis isolated to the renal allograft. The three patients with adequate follow-up presented with a febrile illness 12–26 months after the transplant. The mycobacterial infection was found in the graft nephrectomy specimen in three patients. One patient with renal allograft dysfunction had a percutaneous biopsy that showed tuberculosis. The latter patient recovered renal allograft function after anti-tuberculous therapy. None of the patients had evidence of tuberculosis elsewhere. We conclude that tuberculosis isolated to the renal allograft, especially in an endemic area, may be the cause of renal dysfunction, and appropriate therapy could lead to salvage of the graft.