Chest
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Comparative Study
Yield of bronchoscopy for the diagnosis of tuberculosis in patients with human immunodeficiency virus infection.
The efficacy of bronchoscopy for the diagnosis of tuberculosis in patients infected with human immunodeficiency virus (HIV) has not been systematically evaluated. We therefore compared the diagnostic yield of bronchoscopy in 67 HIV-infected and 45 non-HIV-infected patients with culture-proven pulmonary tuberculosis. In all cases, acid-fast smears of sputum were negative or not obtained prior to bronchoscopy. ⋯ In HIV-infected patients, granulomatous inflammation was noted on transbronchial biopsy in 11 (19 percent) of 59 patients with HIV infection, compared to 16 (43 percent) of 37 patients without HIV infection (p = 0.01). Nevertheless, transbronchial biopsy provided the exclusive means for an early diagnosis of tuberculosis in six (10 percent) of 59 HIV-infected patients. We conclude that the yield of bronchoscopy for the diagnosis of pulmonary tuberculosis in HIV-infected patients is similar to that in patients without HIV infection, and that transbronchial biopsy provides incremental diagnostic information not available from evaluation of sputum or bronchoalveolar lavage fluid.
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We measured interleukin 6 (IL-6) concentrations in the pleural fluid of various patients to determine its role in pathophysiology and diagnosis by using specific functional bioassay. IL-6 levels were significantly higher in exudate than in transudate (79.3 +/- 176.2 U/ml [n = 55] vs 1.7 +/- 1.8 U/ml [n = 12]; p < 0.01). Tuberculous effusion contained a significantly higher amount of IL-6 than malignant effusion (181.3 +/- 176.2 U/ml [n = 13] vs 29.4 +/- 71.5 U/ml [n = 29]; p < 0.005). ⋯ Pleural IL-6 levels were significantly correlated with lactate dehydrogenase (LDH) in pleural fluid (r = 0.392; p < 0.01), ratio of pleural/serum LDH (r = 0.571; p < 0.01), pleural adenosine deaminase activity (r = 0.599; p < 0.01), and serum C-reactive protein (r = 0.494; p < 0.01). Furthermore, IL-6 levels were significantly correlated with peripheral blood platelet counts (r = 0.447; p < 0.001). These results suggest that (1) IL-6 is produced locally in pleural space, (2) pleural IL-6 level is helpful for differential diagnosis, and (3) locally produced IL-6 could leak to circulation and cause systemic effects such as the induction of C-reactive protein and thrombocytosis.
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A patient presented with shortness of breath without fever, cough or sputum production. The patient was hypoxic without leukocytosis and a chest x-ray film demonstrated a right unilateral pulmonary infiltrate. ⋯ During surgical repair, the aneurysm was noted to be compressing the single right pulmonary vein. The infiltrate resolved postoperatively, and the patient has remained symptom-free for one year.