A repetitive sequence of Mycobacterium tuberculosis DNA was amplified by polymerase chain reaction (PCR), from sputum samples, for the diagnosis of pulmonary tuberculosis. The method of heating the sample in a boiling water bath to break down the bacterial cell wall and to release the DNA was compared with that of enzymatic lysis of bacteria and then phenol-chloroform extraction of DNA. Heating the sample was the better method with a sensitivity of approximately 10 microorganisms. A total of 78 sputum specimens prepared by heating were examined by PCR, and the results were compared with the results of acid-fast stained smears, cultures, and clinical data. M. tuberculosis was detected by PCR in all smear- and culture-positive and smear-negative, culture-positive cases. Additionally, PCR was capable of detecting four of nine cases which were smear and culture negative but clinically suspected of tuberculosis. DNA amplification by PCR is a sensitive and specific method for the diagnosis of tuberculosis, and with this simplified DNA isolation procedure it can be used in routine clinical practice.
Twenty patients with tuberculous pleural effusions were studied with ultrasonography. In 18 patients, ultrasonography demonstrated regular pleural thickening which was less than 1 cm except in 1 case. In 4 cases there were a few pleural nodules, whereas in 2 cases the pleural surface showed small nodularity. The latter finding may be diagnostic for a tuberculous etiology. Eighteen patients had multiple, delicate, mobile septations in the effusions, and a lattice-like appearance had formed in 6 cases. Computed tomography was obtained in 7 cases, and pleural thickening was demonstrated in 6 of them. Ultrasonography is a useful imaging modality in the diagnosis of tuberculous pleurisy.
The diagnosis and management of pulmonary hydatid disease represents an important clinical problem in areas of the world endemic to echinococcal infection. We report two patients, ages 14 and 34, respectively, who were admitted to our clinic for investigation of nonresolving pneumonia. Neither had responded to antibiotics prior to admission. Chest x-rays demonstrated lobar collapse and consolidation in both patients. Fiberoptic bronchoscopy revealed laminated membrane of hydatid cyst occluding the bronchus of apicoposterior and anterior segmental bronchi of the left upper lobe in the first patient and the anterior segment of the right upper lobe in the second patient. The diagnoses were confirmed at the time of surgery.
The International Classification of High-resolution Computed Tomography for
Occupational and Environmental Respiratory Diseases (ICOERD) has been developed for
screening and diagnosis of occupational lung diseases. We evaluated the association of
icoerd with the International Labor Organization (ILO) classification and respiratory
functions in pneumoconiosis. Chest x-rays of patients with pneumoconiosis were classified
with ilo and icoerd using hrct, irregular opacity, pleural pathology, and emphysema was
detected in 78, 19, and 53 patients, and using chest x-rays in 47, 4, and 14 patients,
respectively. There was a significant correlation between ILO categories and ICOERD
grades. There was a negative correlation between ILO categories and FEV1% and FVC%,
whereas, ICOERD grades were not correlated with FEV1% and FVC%. HRCT was superior to chest
x-rays to detect pneumoconiosis in early stage, but not in evaluating pulmonary
functions.
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