OBJECTIVE:To determine the incidence of Mycobacterium tuberculosis complex and non-tuberculous mycobacterial isolates in the routine setting of a large general hospital using an "in-house" multiplex polymerase chain reaction method and to establish a paradigm for the definitive identification of mycobacteria isolated using semi-automated equipment.METHODS:Established tests, including polymerase chain reaction restriction enzyme analysis, PNB, and NAP inhibition tests as the gold standard, showed 100% agreement with an IS6110/hsp65 multiplex polymerase chain reaction when used to identify stock strains (n = 117).RESULTS:In a subsequent study, 8,790 clinical specimens producing 476 isolates were evaluated with multiplex PCR and also showed 100% agreement in identification using PRA-polymerase chain reaction as the gold standard. The application of this technique to routine analysis was demonstrated in this study. A method was established with the initial application of multiplex PCR for all positive liquid cultures and the subsequent identification of non-tuberculous mycobacteria by polymerase chain reaction restriction enzyme analysis. In total, 77% of isolates belonged to the Mycobacterium tuberculosis complex, and 23% were non-tuberculous mycobacteria.CONCLUSIONS:Several non-tuberculous mycobacterial species were identified, primarily M. avium, but other potentially pathogenic species were also frequently observed, including M. fortuitum, M. abscessus, and M. kansasii. The expeditious communication of these data to the clinical staff was fundamental for the diagnosis of clinical cases. Even in settings where tuberculosis is of major importance, the incidence of non-tuberculous mycobacteria infection is substantial.
This paper describes the 254 patients with gastric ulcers admitted to the Department of Emergency Surgery of the University of Milan in the period 1978–1983. Long-term results of medical therapy are also evaluated in 103 of these patients, subdivided into two groups: 38 patients (group 1) who were followed at this department by periodic endoscopy and biopsy, and 65 patients (group 2) who were not followed systematically and were reassessed by us only at the end of the study period. In group 1 there were one case of early gastric carcinoma and one case of advanced cancer (both patients underwent radical surgery and are still alive), 10 (26%) recurrences but only one complication (hemorrhage). In group 2, 5 patients died from advanced gastric cancer, and there were 13 (20%) recurrences with 6 complications (5 hemorrhages, 1 perforation) of which 2 were fatal. Our results suggest that medical treatment should be attempted only in selected patients. Furthermore, accurate endoscopic and histologic evaluation before treatment and during regular follow-up is of paramount importance.
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