Diagnostic value of bronchoscopy in smear negative pulmonary tuberculosis / 中国基层医药

Objective To investigate the diagnostic value of bronchoscopy in smear negative pulmonary tuberculosis.Methods 65 cases with cavernous and 35 non -cavernous negative smear pulmonary tuberculosis were examined by bronchoscopy.Results The positive rates of sputum examination in the empty group,the non empty group and the total sputum examination were 49.2%,17.1% and 38%,respectively.There was statistically signifi-cant difference in sputum positive rate between empty group and non empty group (χ2 =9.942,P =0.002).The posi-tive rate of sputum was 28%.The positive rate of sputum negative and sputum positive rate was 10% after operation. Microscopically visible tracheal and bronchial abnormalities,tracheal inflammatory change rates of empty group and non empty group were 52.3%,40.0%,the difference between the two groups had no statistically significant difference (χ2 =1.381,P =0.240).The tracheal stenosis rates of hole group and non empty group were 9.0% and 11.4%,the difference between the two groups had no statistically significant difference (χ2 =0.122,P =0.727).The overall trachea abnormal changes rate was 58.0%,including inflammatory change rate 48.0% and 10.0% stenosis rate. Conclusion Bronchoscopy has significant clinical value in smear negative pulmonary tuberculosis,especially with cavernous.The positive rate will be promoted after bronchoscopy,and can find abnormal changes of tube.

Correlation between liver damage degree and clinical manifestations in patients with pulmonary tuberculosis after chemotherapy / 临床肝胆病杂志

ObjectiveTo explore the correlation between the degree of liver damage and clinical manifestations in patients with pulmonary tuberculosis after chemotherapy. MethodsThis study included 3620 new smear-positive pulmonary tuberculosis patients treated with first-line anti-tuberculosis drug in the Second Central Hospital of Baoding from January 2008 to January 2014, and the follow-up study was carried out to observe medication use and side effects of anti-tuberculosis drug treatment. Comparison of categorical data was made by chisquare test. ResultsA total of 1225 patients (33.8%) exhibited clinical manifestations related to liver injury. The most common clinical manifestation was nausea and vomiting (72.9%), followed by fatigue (37.8%), rash (31.5%), abdominal distension and diarrhea (281%), fever (14.2%), anorexia (3.8%), and other manifestations (2.0%). The nausea and vomiting usually first appeared and were followed by abdominal distension and diarrhea. Of all patients, 243 cases (6.7%) suffered from liver damage and 109 cases (3.0%) had moderate to severe liver damage. Of the patients with clinical manifestations, 171 cases (14.0%) had liver damage and 74 cases(60%) suffered from moderate to severe liver damage. Compared with the patients without clinical manifestations, the relative risks of liver damage and moderate to severe liver damage were 4.643 ［95% confidence interval (CI)=3.035-4.856］ and 4.134 (95% CI=2.817-4.351), respectively, in the patients with clinical manifestations. The patients with fatigue, nausea and vomiting, rash, abdominal distension and diarrhea, anorexia, and other manifestations had higher risk of liver damage and moderate to severe liver damage than those without clinical manifestations (P＜0.05) and the patients with anorexia showed the highest risk. ConclusionOne third of patients with pulmonary tuberculosis have liver injury-related clinical manifestations after chemotherapy. Patients with fatigue, nausea and vomiting, rash, abdominal distension and diarrhea, anorexia, and other manifestations are more susceptible to liver damage and moderate to severe liver damage.

Diagnostic value of adenosine deaminase(ADA) for the tuberculous pleural effusion / 中国基层医药

Objective To investigate the value of adenosine deaminase( ADA) for the diagnosis of tubercu-lous pleural effusion.Methods A retrospective analysis was made of 324 cases of tuberculous pleural effusion patients which were effective treated and 68 cases were diagnosed of malignant pleural effusion.By drawing receiver operating characteristic curve, the best threshold of diagnosing of tuberculous pleural effusion was determined,and the distribution characteristics of ADA in tuberculous pleural effusion were analyzed.Results When the ADA was set at 19.5U/L it was good for identifying tuberculous empyema and tuberculous pleurisy.The activity of ADA in group of different gender did not have significant difference(Z=-0.572,P=0.283).The activity of ADA had significant difference between tuberculous empyema with tuberculous pleurisy patients(Z=-2.317,P=0.01),and the same as in group of different ages between less than or equal to 45 years old with the others(Z=-2.387,P=0.008).The activity of ADA had significant difference between tuberculous empyema and tuberculous pleurisy patients of younger than 45 years old(Z=-2.740,P=0.003),but not in the group of less than or equal to 45 years old (Z=-0.267, P=0.390).Conclusion The activity of ADA is good for identifying diagnosis of tuberculous pleural effusion and malignant pleural effusion, especially in tuberculous empyema and less than or equal to 45 years old patients.The standard of diagnosis and the nature of the tuberculous pleural effusion may affect the cut-off value of ADA.

Measurement and analysis of the lung large tumor respiratory movements of large lung tumors / 肿瘤研究与临床

Objective To measure intrapulmonary tumor motion due to breathing and analyze the impact factors and characteristics of the respiratory movement of large lung tumors.Methods CT sean was conducted in 30 patients with pulmonary cancer,in the calm inspiratory breath-holding and calm breath after breath-holding state.The tumor GTV in the two phases was recorded.The motion range in the left-right and antero-postefior directions in the GTV center level during the respiratory cyele was measured.The motion range of uppermost and lowermost layer of the tumor from top to bottom was also recorded.The clinical variables and anatomical factors assoeiated with the degree of motion were analyzed.Results The position of large lung tumor was relatively fixed,and the motion range was 3-5 mm,but 2 patients movement was found more than 5 mm.The two tumors were located in the lower part and the rear of the chest with low adhesion coefficient and smaller vertical direction of movement.95 ％ of motion range of the intrapulmonary tumors were under 3.8 mm in the vertical direction,under 5.8 mm in the front-rear direction,and under 1.1 mm in the left-right direction.Conclusion The movement of lung tumors caused by respiratory are influenced by tumor location,volume,and other factors such as the degree of adhesion,but the motion ranges are lower.The motion of lower rear tumors mainly occur in the vertical direction with the maximum range.