肺外周孤立性肿块的TBLB的结果观察祆

目的了解经支气管肺活检(TBLB)对疑为周围型肺癌的肺部孤立性肿块的诊断作用.方法分析257例肺部孤立性肿块TBLB结果.结果150例患者获病理标本确诊,其中腺癌55例,鳞癌39例,小细胞未分化癌14例,结核18例,结节病7例,淋巴瘤2例,炎性假瘤1例,曲霉菌病1例,结节型肺泡细胞癌1例,粘液表皮样癌2例,转移性绒癌1例,转移性乳头状瘤1例,无法确定类型的癌有8例,未获得阳性病理结果的有107例.在确诊的腺癌病人中吸烟指数超过400年支的占29%(16/55),鳞癌66%(26/39),小细胞未分化癌的病例占64.7%(11/17).就诊时的症状多为咳嗽,其次为咯血(痰),少部分为胸痛等.结论TBLB针对疑为周围型肺癌的肺部孤立性肿块的诊断,是一种方便、易行、安全、花费较少且较有效果的手段.     

Sputum Examination in the Screening and Diagnosis of Pulmonary Tuberculosis in the Elderly

Pulmonary tuberculosis is not uncommon in the elderly, particularlythose in institutions, and is notoriously difficult to diagnose.Few bacilli are excreted by individuals with non-cavitatingdisease and positive cultures are usually required to confirmthe diagnosis. Radiography is a poor screening method, and therole of the Mantoux test in this population controversial. Thevalue of sputum culture as a screening procedure in elderlypeople with a productive cough was therefore investigated. Ina prospective surveillance study over 26 months, all permanentresidents in homes for the elderly were entered on the basisof a productive cough for 3 weeks or more irrespective of anyknown or presumed cause. Both smears and cultures were performedon sputum specimens, and Mantoux tests and chest radiographswere performed on those who were sputum positive. The 205 subjects investigated yielded 446 smears, seven of whichwere positive for acid-fast bacilli, and 433 cultures, 32 ofwhich were positive for M. tuberculosis. From this 19 patientswith pulmonary tuberculosis were identified, 18 of whom hadnon-cavitating disease on chest radiography. The numbers ofbacilli in these patients were shown to be low and the excretionpattern haphazard. Smears were not sufficiently sensitive todiagnose non-cavitating tuberculosis in this population, andthe sputum must be cultured in order to exclude the diagnosis.Four negative cultures are required in order to exclude thepresence of pulmonary tuberculosis.     

纤维支气管镜检查在抗酸杆菌阴性肺结核诊断中的应用价值

目的:评价纤维支气管镜(纤支镜)检查在痰涂片抗酸杆菌阴性(菌阴)肺结核诊断中的作用.方法:对应用纤支镜检查确诊的92例菌阴且临床表现不典型肺结核病例资料进行回顾性分析.结果:本组39例纤支镜下见支气管黏膜有异常改变,其中29例(74.4%)刷检涂片找抗酸杆菌阳性,活检有结核病理改变23例(59.0%);另外53例病灶位于外周部位,纤支镜下未见明显异常,经支气管肺活检(TBLB)抗酸杆菌阳性42例(79.2%),刷检涂片抗酸杆菌阳性24例(45.3%),支气管肺泡灌洗液涂片检查抗酸杆菌阳性15例(28.3%).结论:对痰涂片抗酸杆菌阴性肺结核,尤其是临床表现不典型者,纤支镜检查有助于明确诊断.     

糖尿病合并菌阴肺结核的MSCT表现

目的:分析糖尿病菌阴肺结核的影像学特征。材料与方法:回顾性分析近年16例糖尿病菌阴肺结核病例的MSCT资料。结果:结核病灶21%出现在不典型部位如下肺基底段、右肺中叶等,37%出现较大斑块影,空洞多发,形状多不规则。结论:病灶重,易出现大的斑块影,不典型部位出现的病灶多于普通肺结核。     

Enumeration of Tubercle Bacilli in Sputum of Patients with Pulmonary Tuberculosis

A method for precise microscopic enumeration of acid-fast bacilli in the sputum of patients with pulmonary tuberculosis is described. The total number of acid-fast bacilli and the number of culturable cell units of tubercle bacilli per milliliter of sputum were determined in 269 specimens from 28 patients collected prior to and/or during chemotherapy, to establish the usefulness of the procedure for evaluation of the effects of chemotherapy. Prior to or very early in the course of therapy, there was good agreement between microscopically and culturally measurable bacilli in 27 of 28 patients. Thereafter, there were systematic divergences in five patients and occasional divergences in most others. Yet, in general, in 20 of the 28 patients, the microscopically determined population provided a useful measure of the number of culturable tubercle bacilli present. Although the microscopic procedure does not allow species identification of mycobacteria or differentiation between viable and nonviable cells, it often provided, within hours rather than days or weeks, useful information on the residual burden of acid-fast bacilli in sputum during chemotherapy. The nature of the disease in those patients in whom microscopy failed to provide useful information is discussed.     

Utility of Transbronchial Biopsy in the Immunocompromised Host With New Pulmonary Radiographic Abnormalities

ObjectiveTo assess how often transbronchial biopsy (TBBx) added unique positive findings apart from other synchronous bronchoscopic sampling techniques including the bronchoalveolar lavage–immunocompromised host (BAL-ICH) panel that justified changes in management in an array of immunocompromised patients with new pulmonary radiographic abnormalities.MethodsWe retrospectively reviewed all bronchoscopies performed at Mayo Clinic Rochester between January 2012 and December 2017; on the basis of the physician’s selection of a BAL-ICH panel, we identified 192 immunocompromised patients who underwent bronchoscopy with both a BAL-ICH panel and TBBx. The results of the BAL-ICH panel and TBBx were compared and subsequent management decisions analyzed from clinical notes. We identified changes in immunosuppressive agents, antibiotics, chemotherapy, goals of care, and decisions on further evaluation and procedures. We assessed whether the TBBx findings added information not identified on the BAL-ICH panel and other bronchoscopic sampling methods performed during the same procedure that justified subsequent management changes.ResultsOf 192 bronchoscopic procedures performed on immunocompromised patients with acute and subacute pulmonary radiographic abnormalities, management changes justified by the unique positive results of the TBBx occurred 28% (51/192) of the time. Those immunocompromised by solid malignant neoplasms and receiving active immunosuppressive therapy had management changes justified 62.1% (18/29) of the time by the TBBx results. No additional fungal organisms were identified on TBBx that were accounted for on the BAL-ICH panel.ConclusionTransbronchial biopsy may add information to other bronchoscopic findings in immunocompromised patients, especially those with solid malignant neoplasms receiving active immunosuppressive treatment. These potential benefits must be weighed against the risks inherent to the procedure.     

菌阴活动性肺结核抗结核治疗后的多层螺旋CT追踪研究

目的:探讨菌阴活动性肺结核抗结核治疗前后CT征象的改变。材料与方法:搜集38例菌阴活动性肺结核,观察治疗前、治疗6个月及12个月后的CT征象改变,并随机抽取38例菌阳活动性肺结核对比观察。结果:菌阴活动性肺结核CT活动性征象中小HT中心结节、树芽征、小叶间隔增厚、肺实变、支气管壁增厚、毛玻璃影、厚壁空洞治疗前的检出率分别为86.84%、52.63%、34.21%、34.21%、68.42%、78.95%和28.95%,治疗12个月后检出率为15.79%、0.0、2.63%、42.11%、0。5.26低两者之间有显著性差异00.00人菌阳活动性肺结核的树芽征及厚壁空洞征象检出率均高于菌阴肺结核组,两者之间有显著性差异(P<0.05)。结论:菌阴活动性肺结核与菌阳活动性肺结核相比CT静态表现与动态演变均有一定特征性。     

糖尿病合并肺结核的CT 诊断

目的 讨论糖尿病合并肺结核的ＣＴ表现特点。方法 本文２８例全部作了常规胸部ＣＴ扫描以及局部病灶区加扫１ｍｍ薄层,９例作了动脉增强扫描,延迟时间分别在注射造影剂８０～１００ｍＬ后的３０ｓ,２ｍｉｎ和５ｍｉｎ。结果 本组２８例共有５１个肺段发现病变,其中肺结核常见部位占７０．６％,少见部位２９．４％,１７例（６０．７％）呈多个肺段病变,１１例（３９．３Ａ％表现为单个肺叶或肺段病变,其中８例发生在少见部     

结核抗体蛋白芯片法对老年肺结核的诊断价值研究

目的探讨结核抗体蛋白芯片法对老年肺结核的诊断价值。方法选择93例肺结核及77例肺部非特异性感染老年患者,均行痰涂片抗酸染色试验,均采用结核分枝杆菌IgG抗体检测试剂盒(蛋白芯片)检测抗结核分枝杆菌脂阿拉伯甘露醇(LAM)、基因工程重组的16 kD和38 kD的IgG抗体,计算两种方法诊断结核分枝杆菌感染的敏感性及特异性;并分别构建受试者工作特征曲线,通过比较曲线下面积(area under the curve,AUC)评价其诊断效能。结果蛋白芯片法和痰涂片抗酸染色试验诊断结核分枝杆菌感染的敏感性分别为68.82%和33.33%,特异性分别为100.00%和97.40%;AUC分别为0.84和0.65,提示蛋白芯片法的诊断效能显著高于痰涂片抗酸染色法,差异有统计学意义(P0.01)。结论蛋白芯片法检测抗结核分枝杆菌LAM、16 kD和38 kD抗体快捷简便,对诊断老年肺结核有较高的实用价值。     

超声引导下经皮肺穿刺对外周型肺部病灶的诊断与技术应用

目的 探讨超声引导下经皮肺穿刺对外周型肺部病灶的诊断价值与技术应用.方法 对237例(241例次)外周型肺部病灶患者进行穿刺活检的方法、诊断率、并发症及影响诊断率的可能因素进行总结.结果 237例中有完整资料者232例,失随访5例.平均每病灶进针1.89次.病理诊断恶性肿瘤123例,诊断符合率95.3%(123/129),其中能明确病理类型者占94.3%(116/123);良性肿瘤6例;良性病变89例.取材满意率94.0%(218/232);不能帮助诊断8例,假阴性6例;出现并发症16例,其中气胸6例(2.5%),咯血10例(4.1%).结论 超声引导下经皮肺穿刺安全、简便、有效并容易操作,为外周型肺部病灶诊断的首选方法.     

A Prospective Study of Hepatic Tuberculosis in 41 Black Patients

Forty-one black patients aged 21 to 75 years with hepatic tuberculosisdiagnosed at liver biopsy were studied prospectively. The livervaried in size and consistency and was tender in 44 per centof patients. Abdominal symploms, weight loss, pyrexia, hepatomegaly,splenomegaly and anaemia were absent in 54, 39, 37, 5, 68 and27 per cent of patients respectively. Twenty-two per cent ofchest radiographs were normal. Liver function tests were oflittle diagnostic value and hepatic imaging techniques oftengave normal results. Acid-fast bacilli, caseation and coexistentliver disease were detected in 59, 51 and 37 per cent of patientsrespectively. Since there was no consistent clinical pattern a high indexof suspicion is necessary if this disease is to be detectedin communities in which tuberculosis is endemic. In patientswith unexplained hepatomegaly or hepatosplenomegaly or pyrexiaof unknown origin liver biopsy provides the only means of makingthis diagnosis.     

对治疗初治菌阳肺结核的疗效影响

目的 :观察短程化疗并用组合药液超声雾化吸入治疗初治菌阳肺结核对患者痰菌阴转的影响。方法 :实验组 35例 :对初治菌阳肺结核病例 ,在短程化疗基础上并用组合药液超声雾化吸入。对照组 32例 :单纯短程化疗观察痰菌阴转情况。结果 :排菌天数实验组 15 .75± 9.2 5d ,对照组为     

Prospective Study of the Clinical Features and Outcomes of Emergency Department Patients with Delayed Diagnosis of Pulmonary Embolism

Objectives: The authors hypothesized that emergency department (ED) patients with a delayed diagnosis of pulmonary embolism (PE) will have a higher frequency of altered mental status, older age, comorbidity, and worsened outcomes compared with patients who have PE diagnosed by tests ordered in the ED.
Methods: For 144 weeks, all patients with PE diagnosed by computed tomographic angiography were prospectively screened to identify ED diagnosis (testing ordered from the ED) versus delayed diagnosis (less than 48 hours postadmission). Serum troponin I level, right ventricular hypokinesis on echocardiography, and percentage pulmonary vascular occlusion were measured at diagnosis; patients were prospectively followed up for adverse events (death, intubation, or circulatory shock).
Results: Among 161 patients with PE, 141 (88%) were ED diagnosed and 20 (12%) had a delayed diagnosis. Patients with a delayed diagnosis were older than ED-diagnosed patients (61 [±15] vs. 51 [±17] years; p < 0.001), had a longer median time to heparin administration (33 vs. 8 hours; p < 0.001), and had a higher frequency of altered mental status (30% vs. 8%; p = 0.01) but did not have a higher frequency of prior cardiopulmonary disease (25% vs. 23%). Patients with a delayed diagnosis had equal or worse measures of PE severity (right ventricular hypokinesis on echocardiography, 60% vs. 58%; abnormal troponin I level, 55% vs. 24%); on computed tomographic angiography, ten of 20 patients with a delayed diagnosis had PE in lobar or larger arteries and >50% vascular obstruction. Patients with a delayed diagnosis had a higher rate of in-hospital adverse events (9% vs. 30%; p = 0.01).
Conclusions: In this single-center study, the diagnosis of PE was frequently delayed and outcomes of patients with delayed diagnosis were worse than those of patients with PE diagnosed in the ED.     

老年肺结核的诊断探讨

目的探讨老年肺结核的诊断要点。方法根据临床表现、伴随疾病、实验室检查及X线表现等方面对32例老年肺结核进行分析，并对非典型与典型肺结核进行2组对比分析。结果老年肺结核确诊时间长，非典型组长于典型组（P〈0．01）；多器官病变、COPD及肺部感染是最常见的伴随疾病，肺部感染及多器官病变的发生率非典型组高于典型组（P〈0．05）：PPD试验强阳性率及抗结核抗体阳性率较低：PPD阴性的发生率非典型组高于典型组（P〈0．05）：多肺段病变、空洞和／或钙化、纤维索条影、渗出性病变及胸膜改变的发生率高，胸膜改变的发生率非典型组高于典型组（P〈0．05）。结论老年肺结核不典型，病程长，诊断必须根据症状、实验室检查及X线表现综合判断：对于迁延不愈的多发肺部感染，伴胸膜改变应警惕结核的可能，条件允许应实施抗痨治疗。     

N-Acetyltransferase Genotypes and the Pharmacokinetics and Tolerability of para-Aminosalicylic Acid in Patients with Drug-Resistant Pulmonary Tuberculosis

The aim of this study was to examine the relationships between N-acetyltransferase genotypes, pharmacokinetics, and tolerability of granular slow-release para-aminosalicylic acid (GSR-PAS) in tuberculosis patients. The study was a randomized, two-period, open-label, crossover design wherein each patient received 4 g GSR-PAS twice daily or 8 g once daily alternately. The PAS concentration-time profiles were modeled by a one-compartment disposition model with three transit compartments in series to describe its absorption. Patients'' NAT1 and NAT2 genotypes were determined by sequencing and restriction enzyme analysis, respectively. The number of daily vomits was modeled by a Poisson probability mass function. Comparisons of other tolerability measures by regimens, gender, and genotypes were evaluated by a linear mixed-effects model. The covariate effects associated with efavirenz, gender, and NAT1*3, NAT1*14, and NAT2*5 alleles corresponded to 25, 37, −17, −48, and −27% changes, respectively, in oral clearance of PAS. The NAT1*10 allele did not influence drug clearance. The time above the MIC of 1 mg/liter was significantly different between the two regimens but not influenced by the NAT1 or NAT2 genotypes. The occurrence and intensity of intolerance differed little between regimens. Four grams of GSR-PAS twice daily but not 8 g once daily ensured concentrations exceeding the MIC (1 mg/liter) throughout the dosing interval; PAS intolerance was not related to maximum PAS concentrations over the doses studied and was not more frequent after once-daily dosing. We confirm that the slow phenotype conferred by the NAT1*14 and NAT1*3 alleles resulted in higher PAS exposure but found no evidence of increased activity of the NAT1*10 allele.     

骨髓移植后肺部弥漫性病变纤维支气管镜诊断

为了评估骨髓移植术后肺部弥漫性病变诊断中纤维支气管镜检（fibroptic bronchoscopy，FB）的应用价值，对2003年11月-2006年3月间18例骨髓移植术后出现肺部弥漫性病变、短期经验治疗效果欠佳的患者行FB，并做支气管肺泡灌洗（BAL）及刷检涂片，其中3例条件许可者加支气管镜肺活检（TBLB）。结果发现，18例骨髓移植术后患者10例为肺部感染，8例为非感染性肺部并发症。10例肺部感染患者9例通过FB明确诊断，包括细菌性肺炎3例，真菌感染2例，卡氏肺囊虫3例，病毒性肺炎1例。1例接受2次BAL，无阳性结果，开胸肺活检确诊为结核。8例非感染性肺部并发症患者中2例通过TBLB明确诊断。结论：FB特别是BAL是一种安全、有效的检查方法，对白血病骨髓移植后肺部并发症尤其感染性肺部并发症的诊断率高；奈件许可者应尽可能行TBLB，以提高移植后非感染并发症诊断，减少开胸肺活检。     

常规X线与多层螺旋CT在肺结核诊断与鉴别中的应用价值对比

目的探讨常规X线与多层螺旋CT在肺结核诊断、鉴别中的作用。方法选取2015年3月~2016年2月我院收治的肺结核患者114例为研究对象,分别接受常规X线检查、多层螺旋CT检查,观察两种检查方法诊断准确性、隐藏病灶显示情况以及病灶分布显示情况。结果常规X线检查确诊94例,诊断准确率为85.96%,多层螺旋CT检查确诊110例,诊断准确率为96.49%,差异有统计学意义(P0.05);常规X线隐藏病灶明确显示率为13.79%,多层螺旋CT隐藏病灶明确显示率为100.00%,差异有统计学意义(P0.05);204个病灶中,常规X线检出92个,检出率为45.10%,多层螺旋CT检出198个,检出率为97.06%,差异有统计学意义(P0.05)。结论肺结核患者接受多层螺旋CT检查,具有较高准确性,可对隐藏病灶以及病灶分布情况予以显示,在疾病诊断与鉴别中具有更高价值。     

经CT及纤维支气管镜肺穿刺活检对肺结节病变诊断的价值

目的：探讨CT引导经皮肺穿刺知检及纤维支气管镜活检对肺结节性病变的诊断价值。材料与方法：28例肺结节性病灶分别作CT引导经皮肺穿刺及纤维支气管镜肺穿刺活检。结果：CT引导穿刺准确率92．86％（26／28），诊断符合率85．71％（24／28）；纤维支气管镜穿刺准确率60．71％（17／28），诊断符合率50％（14／28）。结论：CT引导肺穿刺活检是一种对肺结节性病变诊断准确性高的有效方法。     

3-D Ultrasound and Thyroid Cancer Diagnosis: A Prospective Study

This study tests the hypothesis that evaluation of thyroid nodule (TN) margin irregularities by three-dimensional ultrasound (3-D-US) distinguishes benign from malignant TNs with greater sensitivity and specificity than two-dimensional ultrasound (2-D-US). We prospectively evaluated 344 TNs using both 2-D-US and 3-D-US followed by fine needle aspiration biopsy. TNs were divided into four groups based on the 3-D-US appearance of the margins. Bi-variate and multi-variate analyses were used. Surgical pathology confirmed 44 thyroid cancers in 40 patients. For 2-D-US, irregular margins and micro-calcifications (p < 0.001) were found more frequently in malignant TNs. Irregular margins on 2-D-US had a sensitivity and specificity of 61.4% and 79.3%, respectively. Irregular margins on 3-D-US had a sensitivity and specificity of 86.4% and 83.3%, respectively. Sensitivity, specificity, positive and negative predictive values were higher for irregular margins on 3-D-US than micro-calcifications and irregular margins on 2-D-US. Evaluation of TN margins by 3-D-US distinguished benign from malignant TNs with greater sensitivity and specificity than 2-D-US.