Risk factors for multidrug-resistant bacterial infection among patients with tuberculosis

Given that anti-tuberculosis medication itself has antibacterial activity and that broad-spectrum antibiotics are frequently used, the emergence of multidrug-resistant (MDR) bacteria among patients being treated for tuberculosis (TB) is likely. We used a case-control design to study the clinical predictors of MDR bacterial infection among TB patients. Both cases and controls were selected from among patients who were diagnosed and treated as having TB between 1 January 1996 and 31 August 2006. TB patients with MDR bacterial infection were included as cases and those with non-MDR bacterial infection were included as controls. Multiple logistic regression analysis was performed to elucidate the risk factors for MDR bacterial infection. During the study period 3667 patients were diagnosed with, and treated for, TB. A total of 123 experienced episodes of bacterial infection, of whom 59 (48.0%) were infected by an MDR strain at least once. The presence of chronic renal failure [adjusted odds ratio (OR): 4.96; 95% confidence interval (CI): 1.37-18.01] and the use of antimicrobials other than typical anti-TB drugs within three months (adjusted OR: 4.37; 95% CI: 1.74-10.95) were independent risk factors for MDR bacterial infection. Bacterial infection in TB patients is commonly multidrug resistant. Clinicians should be aware of the possibility of MDR bacterial infection among TB patients with chronic renal failure or recent use of other antimicrobials.

Rapid increase of non-tuberculous mycobacterial lung diseases at a tertiary referral hospital in South Korea

The incidence of non-tuberculous mycobacteria (NTM) disease is thought to correlate negatively with the tuberculosis (TB) burden. To determine the recent trend in the number of patients with NTM lung disease at a tertiary referral hospital in South Korea, where the incidence of TB has been stationary, a retrospective analysis was performed. From 2002 to 2008, the number of patients with NTM lung diseases increased from 82 to 133, while the number of TB patients decreased from 436 to 276. NTM lung diseases might be increasing in South Korea despite the stationary incidence of TB.

The treatment of diabetic foot ulcers with uncultured, processed lipoaspirate cells: a pilot study

Human processed lipoaspirate (PLA) cells are relatively easy to obtain in large quantities without cell culture. The purpose of this study was to present the possibility of using uncultured PLA cell autografts for the treatment of diabetic ulcers. An in vitro study was designed initially to determine the effect of PLA cell autografts on the proliferation and collagen synthesis of diabetic fibroblasts (n=4). In a subsequent clinical study, 26 patients with diabetic foot ulcers were treated using PLA cell autografts. Control treatment was also performed in 26 patients. Eight weeks after treatment, the percentages of complete healing and mean healing times were compared. Cell proliferation and collagen synthesis in the PLA cell treatment group were 28 and 44% higher than that in the control group in vitro, respectively. Our clinical study showed that 100% of the PLA cell-treated group and 62% of the control group achieved complete healing. The PLA cell treatment was also superior to the conventional method in terms of the healing time. No adverse events related to the study treatment occurred. Uncultured PLA cell autografts stimulate the activity of diabetic fibroblasts and may offer a simple and effective treatment for diabetic ulcers.

The impact of insulin sensitisers on lung function in patients with chronic obstructive pulmonary disease and diabetes

SETTING

It has been reported that diabetes mellitus (DM) is associated with poor pulmonary function, which could be explained by insulin resistance.

OBJECTIVE

To evaluate whether insulin sensitisers (ISs) have beneficial effects on lung function in patients with chronic obstructive pulmonary disease (COPD) and DM.

DESIGN

This retrospective study included patients with both COPD and DM who attended Seoul National University Hospital for treatment between 1 January 2000 and 31 August 2007. They were treated with inhalers for COPD and oral hypoglycaemia agents, including ISs or insulin, for DM. The primary outcome was a change in lung function in spirometric examinations.

RESULTS

Among 61 patients enrolled, 32 were in the no IS group, while 29 were in the IS group. On multivariable regression analysis, the IS group showed a significantly greater change in forced vital capacity (FVC) than the no IS group (adjusted beta-coefficient 131.9, 95%CI 8.5-255.4, P = 0.04).

CONCLUSIONS

Treatment with an IS was independently associated with improvements in FVC in patients with both COPD and DM, compared with treatment without IS.

The impact of nutritional deficit on mortality of in-patients with pulmonary tuberculosis

SETTING

A metropolitan governmental medical centre, Seoul, Republic of Korea.

OBJECTIVE

To elucidate the impact of the nutritional deficit assessed by the Nutritional Risk Score (NRS) on the outcomes of in-patients with pulmonary tuberculosis (PTB).

DESIGN

All hospitalised patients with microbiologically confirmed PTB were enrolled. A four-point NRS included low body mass index (<18.5 kg/m(2)), hypoalbuminaemia (<30.0 g/l), hypocholesterolaemia (<2.33 mmol/l) and severe lymphocytopaenia (<7 x 10(5) cells/l). The primary outcome was overall in-hospital mortality. The degree of radiographical resolution after anti-tuberculosis treatment was also evaluated.

RESULTS

In a total of 156 patients, the male to female ratio was 1.6:1. The overall mortality was 13.5% and tuberculosis-specific fatality was 3.9%. Predisposing factors and high NRS (> or = 3 points) were independent risk factors for in-hospital death after adjusting for the severity of PTB. High NRS (OR = 16.8, P < 0.001) and predisposing factors (OR = 5.4, P = 0.032) were independent risk factors for 30-day survival. The NRS was not associated with radiographic improvement.

CONCLUSION

Regardless of disease severity, the high NRS was a significant negative predictor among in-patients with PTB; this finding should therefore be considered in the management of PTB despite the current era of effective anti-tuberculosis chemotherapy.

Isolation and characterization of bacteriocin-producing bacteria from the gastrointestinal tract of broiler chickens for probiotic use

AIMS

To isolate and characterize the bacteriocin-producing bacteria (BPB) from the gastrointestinal tract of broiler chickens for probiotic use.

METHODS AND RESULTS

In total, 291 bacterial strains were isolated from broilers and screened for bacteriocin-producing ability. The bacteriocins produced by Enterococcus faecium SH 528, Ent. faecium SH 632 and Pediococcus pentosaceus SH 740 displayed inhibitory activity against pathogens including Clostridium perfringens and Listeria monocytogenes. Activity of the bacteriocins remained unchanged after 30 min of heat treatment at 60 degrees C or exposure to organic solvents, but diminished after treatment with proteolytic enzymes. PCR was used to detect the structural genes enterocin A and B in SH 528, enterocin L50 and P in SH 632, and pediocin PA-1 in SH 740. Most of them were resistant to 0.5% bile salts and remained viable after 2 h at pH 3.0. Ent. faecium SH 528 exhibited the highest amylase activity among the strains tested.

CONCLUSIONS

We selected Ent. faecium SH 528 and SH 632 and Ped. pentosaceus SH 740 by probiotic selection criteria including inhibition activity against pathogens.

SIGNIFICANCE AND IMPACT OF THE STUDY

The isolated BPB could potentially be used in the poultry industry as probiotics to control pathogens.

Effect of human bone marrow stromal cell allograft on proliferation and collagen synthesis of diabetic fibroblasts in vitro

In previous pilot studies, the authors reported that bone marrow stromal cells (BSCs) have a superior effect on healing of acute wounds compared with fibroblasts in vitro and in vivo. The present study was designed to compare the effect of allograft of normal BSCs with that of normal fibroblasts on the activity of diabetic fibroblasts in vitro. Diabetic fibroblasts were cultured in 24-well culture plates. Three groups were evaluated: group I, diabetic fibroblasts only; group II, diabetic fibroblasts co-cultured with normal fibroblasts; group III, diabetic fibroblasts co-cultured with normal BSCs. After 3-day incubation, cell proliferation and collagen synthesis, which are the major contributing factors in wound healing, were measured. Group III showed the highest level in both cell proliferation and collagen synthesis, followed by group II and group I (p<0.05). These results demonstrate that BSCs are superior to fibroblasts in stimulating the activity of diabetic fibroblasts.

Studies on red cell carbonic anhydrase types in Korean cattle

Red cell carbonic anhydrase types in Korean cattle were investigated by means of starch gel electrophoresis. A carbonic anhydrase zone (X) located ahead zone F was found in 12 out of 502 Korean cattle. The distribution of CA phenotypes in 490 Korean cattle was CA FS type 92 and CA SS type 398. The CA FF type has not yet been recognized in Korean cattle. The gene frequencies were CAF = 0.094 and CAS = 0.906. No statistically significant differences were observed between gene frequencies in cattle from six different Korea provinces.

Studies on hemoglobin variants in Korean cattle

814 hemoglobin samples from Korean cattle were investigated by starch gel electrophoresis for the detection of hemoglobin variants. A new variant of cattle hemoglobin, called Hb, H, was recognized. It has a slower rate of migration than Hb A. Hemoglobin types from 814 Korean cattle were as follows: 652 of Hb AA type (80.1%), 133 of Hb AB (16.4%), 12 of Hb AC (1.5%), 9 of Hb BB (1.1%), 2 of Hb BC (0.2%), 4 of Hb AH (O.5%), 1 of Hb CH (0.1%), 1 of Hb HH (O.1%). These figures correspond to the frequencies: HbA = 0.893, HbB = 0.093, HbC = 0.009, HbH = 0.004.

Is the foot elevation the optimal position for wound healing of a diabetic foot?

In managing diabetic foot ulcers, foot elevation has generally been recommended to reduce oedema and prevent other sequential problems. However, foot elevation may decrease tissue oxygenation of the foot more than the dependent position since the dependent position is known to increase blood flow within the arterial system. In addition, diabetic foot ulcers, which have peripheral vascular insufficiency, generally have less oedema than other wounds. Therefore, we argue that foot elevation may not be helpful for healing of vascularly compromised diabetic foot ulcers since adequate tissue oxygenation is an essential factor in diabetic wound healing. The purpose of this study was to evaluate the influence of foot height on tissue oxygenation and to determine the optimal foot position to accelerate wound healing of diabetic foot ulcers. This study included 122 cases (73 males and 47 females; two males had bilateral disease) of diabetic foot ulcer patients aged 40-93 years. Trans-cutaneous partial oxygen tension (TcpO(2)) values of diabetic feet were measured before and after foot elevation (n=21). Elevation was achieved by placing a foot over four cushions. We also measured foot TcpO(2) values before and after lowering the feet (n=122). Feet were lowered to the patient's tibial height, approximately 30-35 cm, beside a bed handrail. Due to the large number of lowering measurements, we divided them into five sub-groups according to initial TcpO(2.) Tissue oxygenation values were compared. Foot-elevation-lowered TcpO(2) values before and after elevation were 32.5+/-22.2 and 23.8+/-23.1 mmHg (p<0.01), respectively. Foot-lowering-augmented TcpO(2) values before and after lowering were 44.6+/-23.8 and 58.0+/-25.9 mmHg (p<0.01), respectively. The lower the initial TcpO(2) level, the more the TcpO(2) level increased. The foot lowering, rather than elevation, significantly augments TcpO(2) and may stimulate healing of diabetic foot ulcers.

Decreased phosphorylation of STAT-1, STAT-4 and cytokine release in MDR-TB patients with primary resistance

SETTING

We recently showed that treatment failure rate was higher among multidrug-resistant tuberculosis (MDR-TB) patients without a previous history of tuberculosis (TB) treatment, or so-called 'primary resistance'.

OBJECTIVE

To investigate the phosphorylation levels of signal transducers and activators of transcription-1 (STAT-1) and STAT-4 and the subsequent cytokine release as a possible cause of a poor prognosis in MDR-TB patients with primary resistance.

DESIGN

Ten patients with successfully treated pulmonary TB without resistance, 12 MDR-TB patients with acquired resistance and 10 MDR-TB patients with primary resistance were enrolled. After 24 h stimulation of peripheral blood mononuclear cells (PBMC) with interferon-gamma (IFN-gamma), interleukin-12 (IL-12), purified protein derivative (PPD), or lysate of Mycobacterium tuberculosis, flow cytometric analysis of intracellular pSTAT-1 and pSTAT-4 were performed and secretion of IFN-gamma, IL-12p40 and tumour necrosis factor-alpha (TNF-alpha) was measured in culture supernatant.

RESULTS

The mean fluorescent intensities of pSTAT-1 and pSTAT-4 in PBMC of MDR-TB patients with primary resistance decreased on stimulation of IFN-gamma, PPD or lysate of M. tuberculosis when compared with patients with acquired resistance. In addition, secretion of IFN-gamma, IL-12p40 and TNF-alpha in these patients decreased on various stimuli.

CONCLUSION

Decreased phosphorylation of STAT-1, STAT-4, and of subsequent cytokine release, might be associated with a poor prognosis in MDR-TB patients with primary resistance.

Isolation and partial characterization of a bacteriocin produced by Pediococcus pentosaceus K23-2 isolated from Kimchi

AIMS

Screening and partial characterization of a bacteriocin produced by Pediococcus pentosaceus K23-2 isolated from Kimchi, a traditional Korean fermented vegetable.

METHODS AND RESULTS

A total of 1000 lactic acid bacteria were isolated from various Kimchi samples and screened for the production of bacteriocin. Pediocin K23-2, a bacteriocin produced by the Pediococcus pentosaceus K23-2 strain, showed strong inhibitory activity against Listeria monocytogenes. The bacteriocin activity remained unchanged after 15 min of heat treatment at 121 degrees C or exposure to organic solvents; however, it diminished after treatment with proteolytic enzymes. The bacteriocin was maximally produced at 37 degrees C, when the pH of the culture broth was maintained at 5.0 during the fermentation, although the optimum pH for growth was 7.0. The molecular weight of the bacteriocin was about 5 kDa according to a tricine SDS-PAGE analysis.

CONCLUSIONS

Pediococcus pentosaceus K23-2 isolated from Kimchi produces a bacteriocin, which shares similar characteristics to the Class IIa bacteriocins. The bacteriocin is heat stable and shows wide antimicrobial activity against Gram-positive bacteria, especially L. monocytogenes.

SIGNIFICANCE AND IMPACT OF THE STUDY

Pediocin K23-2 and pediocin K23-2-producing P. pentosaceus K23-2 could potentially be used in the food and feed industries as natural biopreservatives, and for probiotic application to humans or livestock.

Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis

The effects of malnutrition on outcomes in miliary tuberculosis (MTB) are not well described. The aim of the present study was to find predictors for the development of acute respiratory failure (ARF) and survival in MTB patients, focusing on parameters reflecting nutritional condition. Out of the patients from three hospitals who had microbiologically or histopathologically confirmed tuberculosis, 56 patients presenting with typical disseminated pulmonary nodules on radiographs were retrospectively enrolled. A four-point nutritional risk score (NRS) was defined according to the presence of four nutritional factors: low body mass index (BMI; <18.5 kg x m(-2)), hypoalbuminaemia (<30.0 g x L(-1)), hypocholesterolaemia (<2.33 mmol x L(-1)) and severe lymphocytopenia (<7 x 10(5) cells x L(-1)). The male to female ratio was 1:3. ARF developed in 25% of patients (14 out of 56), with a 50% fatality rate. A high NRS (> or =3 points) was an independent risk factor for the development of ARF and fatality. In 90-day survival analysis, ARF, severe lymphocytopenia, hypocholesterolaemia, low BMI and higher NRS were risk factors for poor outcome. In multivariate analysis, only high NRS was an independent risk factor for 90-day survival rate in patients with MTB. A high nutritional risk score was a good predictor of poor outcome in miliary tuberculosis patients. Additional approaches to recover the nutritional deficits may become a focus in future management of miliary tuberculosis.

Potential use of blood bank platelet concentrates to accelerate wound healing of diabetic ulcers

Many clinical trials have shown the effectiveness of platelet releasates on diabetic wound healing, but large volumes of blood must be aspirated from patients and a platelet separator is required. This study was undertaken to investigate the potential of blood bank platelet concentrate (BBPC) for accelerating diabetic wound healing. Platelet-derived growth factor-BB (PDGF-BB) contents in BBPC were determined by enzyme-linked immunosorbent assay in vitro, and the in vivo study involved comparing extents of wound healing in BBPC-treated and control groups using diabetic mouse wound models. In the in vitro study, 5.2 +/- 1.2 pg of PDGF-BB was found to be released by 1 million platelets in fresh BBPC, and adding thrombin to BBPC significantly increased the levels of PDGF-BB released. Our in vivo study in diabetic mice revealed that BBPC treatment greatly accelerated wound healing. Our results suggest that BBPC has potential to accelerate the healing of diabetic ulcers.

Updated anatomy of the dermocartilaginous ligament of the nose

Pitanguy conducted a series of anatomic studies on the dermocartilaginous ligament of the nose. However, information on its structure is as yet insufficient. In addition, some of the histologic findings described by Pitanguy are controversial. The present study was undertaken to clarify the anatomy of the dermocartilaginous ligament. Sixteen cadaver noses were examined macroscopically and histologically to determine the presence, origin, insertion, composition, and relationship of the dermocartilaginous ligament with surrounding structures. There was no direct connection between the dermocartilaginous ligaments and dorsal nasal skin. This structure originated from the deep layer of the transverse nasalis muscle and terminated at the caudal edge of the septal cartilage and orbicularis oris muscle in some cases. Our histologic findings were incompatible with the use of the term ligament and demonstrated that it was in fact a fascia. Unlike Pitanguy's findings, no muscle fibers or chondrocytes were identified within the dermocartilaginous ligament.

Oxidation of flame retardant tetrabromobisphenol A by singlet oxygen

Wide use of flame retardants can pose an environmental hazard, and it is of interest to investigate how they may degrade. We report here that 3,3',5,5'-tetrabromobisphenol A (TBBPA) is subject to photosensitized oxidation involving singlet molecular oxygen ((1)O2). By using visible light and rose bengal or methylene blue as 102 photosensitizers, we have found that TBBPA is a 102 quencher. The quenching rate constant, k(q), depends on TBBPA ionization (pK = 7.4). In acetonitrile, where TBBPA is undissociated, the kq value is 6.1 x 10(5) M(-1) s(-1) for a TBBPA monomer and decreases to 2.9 x 10(4) M(-1) s(-1) for TBBPA dimers and/or aggregates. TBBPA dissociates in aqueous solutions, and its kq value is 1.44 x 10(9) M(-1) s(-1) in alkaline solution, decreasing to 3.9 x 10(8) M(-1) s(-1) at pH 7.2. The strong 102 quenching by TBBPA anion initiates an efficient oxidation of TBBPA, which results in oxygen consumption in aqueous micellar (e.g., Triton X-100) solutions containing photosensitizer. This oxygen consumption is mediated by transient radical species, which we detected by using EPR spectroscopy. We observed two major radicals and one minor radical generated from TBBPA by reaction with 102 at pH 10. One was identified as the 2,6-dibromo-p-benzosemiquinone radical (a2H = 2.36 G, g = 2.0056). A second radical (aH = 2.10 G, g = 2.0055) could not be identified butwas probably a 2,6-dibromo-p-benzosemiquinone radical containing an EPR-silent substituent at the 3-position. Spin trapping with 5,5-dimethyl-1-pyrroline N-oxide (DPMO) showed that other minor radicals (hydroxyl, carbon-centered) are also generated during the reaction of TBBPA with (1)O2. The photosensitized production of radicals and oxygen consumption were completely inhibited by the azide anion, an efficient physical (1)O2 quencher. Because TBBPA is a stable compound that at neutral pH does not absorb much of the atmosphere-filtered solar radiation, its photosensitized oxidation by (1)O2 may be the key reaction initiating or mediating TBBPA degradation in the natural environment.

Predictors of persistent airway stenosis in patients with endobronchial tuberculosis

SETTING

The university and municipal hospitals in Seoul, Korea.

OBJECTIVE

To evaluate the predictors of persistent airway stenosis following anti-tuberculosis chemotherapy in patients with endobronchial tuberculosis (TB).

DESIGN

Diagnosis of TB was confirmed by microbiology or histopathology. Bronchoscopic examinations revealed that patients had endobronchial lesions compatible with endobronchial TB. Study subjects had at least one follow-up bronchoscopy to evaluate their treatment response. Treatment response was determined by changes in the degree or extent of airway stenosis between the first and last bronchoscopic examinations.

RESULTS

Sixty-seven subjects were recruited retrospectively from Seoul National University Hospital and Seoul National University Boramae Hospital. Persistent bronchostenosis occurred in 41.8% of the patients. In multivariate regression analysis, age >45 years (OR 3.65), pure or combined fibrostenotic subtype (OR 5.54) and duration from onset of chief complaint to the initiation of anti-tuberculosis chemotherapy >90 days (OR 5.98) were identified as independent predictors of persistent airway stenosis. Oral corticosteroids (prednisolone equivalent >or=30 mg/d) did not reduce the frequency of persistent airway stenosis.

CONCLUSION

Early diagnosis and early administration of anti-tuberculosis chemotherapy before involvement of the deeper airways is important to prevent the development of unwanted sequelae of bronchostenosis.

Anatomy of the alar lobule in the Asian nose

OBJECTIVE

To provide details of the unique anatomical features on the alar lobule region in the Asian nose.

METHODS

We hypothesized that the shape of the alar lobule is dependent on its anatomy. The alar lobules were classified into flared type and straight type depending on their gross prominence and roundness. A total of 20 fresh cadaver noses (10 of each type) were dissected. Anatomical differences between the flared and straight types were investigated by gross and histologic studies.

RESULTS

The alar lobule consisted of three layers; external skin, muscle, and vestibular skin. The dilator naris anterior and dilator naris posterior muscles were well developed in the flared type alar lobules, whereas they were poorly developed in the straight type. The insertion of the dilator naris posterior muscle in the flared type was found to extend more anteriorly to the middle of alar lobule as well as to the alar base, whereas in the straight type the insertion was limited to the alar base only. External skin at the lateral end of the flared type was thicker than of the straight type. No significant differences were seen in other structures of the alar lobule region.

CONCLUSIONS

The gross appearance of the alar lobule is mainly affected by the volume of the dilator naris anterior muscle, the insertion of the dilator naris posterior muscle, and the thickness of the external skin at the lateral end of the alar circumference.

Dermis Graft for Wound Coverage

BACKGROUND

The two major concerns in skin grafting are poor color match in the recipient sites and donor-site morbidity. A dermis graft, which is a de-epithelialized split-thickness skin graft, was used to minimize these problems. The important aspects of this method involve the immediate return of the epidermis to the donor site and the restoration of the epidermis portion of the recipient site by inducing epithelization from the adjacent skin.

METHODS

From April of 2001 to March of 2004, the dermis graft was applied to 53 patients. A regular split-thickness skin graft procedure was performed in 33 patients. Healing time, scar condition, and patient satisfaction were compared.

RESULTS

The wounds of the dermis (n = 53) and skin grafts (n = 33) had re-epithelialized after 15.5 +/- 1.9 and 11.8 +/- 1.6 days, respectively. Scarring on the recipient site of the dermis graft (n = 26) was less severe than that on the regular skin graft (n = 20) in terms of pigmentation, height, and vascularity (p < 0.05). No significant difference in pliability was detected. Patient satisfaction with the dermis graft group was also better. The donor sites of the dermis graft (n = 53) and skin graft (n = 33) healed within 7.5 +/- 0.8 and 12.8 +/- 1.1 days, respectively. The donor sites of the dermis graft (n = 26) were also superior to those of the skin graft (n = 20) in terms of scar quality and patient satisfaction.

CONCLUSION

The dermis graft technique for wound coverage is superior both aesthetically and functionally to the regular skin graft technique in both the recipient and donor sites.

Aetiologies and predictors of pulmonary cavities in South Korea

OBJECTIVE

To identify the aetiologies of pulmonary cavities and the clinical predictors of cavities of mycobacterial origin.

SETTING

A tertiary referral hospital in South Korea, where the prevalence of tuberculosis (TB) is intermediate.

DESIGN

A retrospective review of clinical records and radiographic examinations of patients presenting pulmonary cavities on simple chest radiograph between January and December 2005.

RESULTS

Of 131 patients enrolled with pulmonary cavities, 66 (50.4%) had cavities of mycobacterial origin. Age <50 years (P = 0.04) and largest cavity located in the upper lobes (P = 0.04) increased the likelihood that the cavities were of mycobacterial origin. Conversely, history of malignancy (P = 0.02), lesions confined to one lobe (P = 0.02) and multiple enlarged mediastinal lymph nodes (P = 0.03) suggested a non-mycobacterial cause.

CONCLUSION

Mycobacterial infection accounted for half of the cavitary lesions identified in this study. In older patients with a history of malignancy, non-nodular infiltration, lesions confined to one lobe and with multiple lymphadenopathy, diseases not caused by mycobacteria should be considered.

Determinants of diagnostic bronchial washing in peripheral lung cancers

OBJECTIVE

To establish clinical determinants affecting the diagnostic yield of bronchial washing.

SETTING

We performed bronchial washing in 241 consecutive patients with bronchoscopically invisible lung tumours. Of these, 150 patients known to have lung cancer were enrolled for the final analysis.

DESIGN

A multi-centre study.

RESULTS

Bronchial washing provided a diagnosis of lung cancer in 30 of the 150 patients (20%). Tumour size > or = 3 cm (P = 0.005), the location of the tumour within 8 cm of the carina (P = 0.003), and exposed type bronchus sign of tumour (P < 0.001) were factors affecting diagnostic bronchial washing for bronchoscopically invisible lung cancers. However, multivariate logistic regression revealed that exposed type bronchus sign was the sole determinant (OR 19.22, 95% CI 4.23-87.46, P < 0.001).

CONCLUSION

Bronchial washing is a useful procedure for the diagnosis of bronchoscopically invisible lung cancers. As the tumour-bronchus relationship is the most important determinant of a diagnostic yield, the routine use of bronchial washing should be considered for tumours with exposed type bronchus sign.

Factors affecting nostril shape in Asian noses

BACKGROUND

Because few studies have been performed regarding the factors affecting nostril shape in Asian noses, this study was undertaken to determine them.

METHODS

A total of 20 fresh cadaver noses were classified into horizontal and vertical types and dissected. The authors investigated the presence, volume, and insertions of muscles surrounding the ala; alar cartilage shape; footplate segment ratio of the medial crus; and the characteristics of tip supporting structures.

RESULTS

Horizontal nostril types had larger dilator naris anterior and posterior muscular components. In particular, the insertion of the dilator naris posterior muscle extended to the midpoint between the alar base and the nasal tip, whereas that of the vertical type was limited to the alar base. Insertion of the depressor septi nasi muscle was also more extensive in horizontally oriented nostrils. In terms of the shape of the lower lateral cartilage, the horizontal nostril type had a predominantly concave configuration of the lateral crus, whereas the vertical nostril type had the opposite concave configuration. A significant difference was also noted in the footplate segment ratio of the medial crus. However, no differences were observed in terms of the shape of the medial crus and the characteristics of the tip supporting structures.

CONCLUSIONS

Nostril shape is mainly affected by the volume of the dilator naris anterior and posterior muscle, the insertions of the dilator naris posterior and the depressor septi nasi muscle, the shape of the lateral crus, and the footplate segment ratio.

Prognostic factors for surgical resection in patients with multidrug-resistant tuberculosis

Although surgical lung resection could improve prognosis in some patients with multidrug-resistant tuberculosis (MDR-TB), there are no reports on the optimal candidates for this surgery. The aim of the present study was to elucidate the prognostic factors for surgery in patients with MDR-TB. Patients who underwent lung resection for the treatment of MDR-TB between March 1993 and December 2004 were included in the present study. Treatment failure was defined as greater than or equal to two of the five cultures recorded in the final 12 months of treatment being positive, any one of the final three cultures being positive, or the patient having died during treatment. The variables that affected treatment outcomes were identified through univariate and multivariate logistic regression analysis. In total, 79 patients with MDR-TB were included in the present study. The treatment outcomes of 22 (27.8%) patients were classified as failure. A body mass index <18.5 kg x m(-2), primary resistance, resistance to ofloxacin and the presence of a cavitary lesion beyond the range of the surgical resection were associated with treatment failure. Low body mass index, primary resistance, resistance to ofloxacin and cavitary lesions beyond the range of resection are possible poor prognostic factors for surgical lung resection in multidrug-resistant tuberculosis patients.