Yield of AFB by direct sputum smear examination with bronchial washings and post bronchoscopy sputum smear examination

Background and objectives: The objective of the present study is to evaluate the yield of AFB by direct sputum smear examination with Bronchial Washings and Post Bronchoscopy sputum smear examination. Materials and methods: This prospective study was conducted on 100 patients with suspected pulmonary TB October 2015 – September 2017 at S.V.S Medical College, Mahabubnagar. Results: Out of 100 clinically suspected, sputum smear negative cases, 38 cases were diagnosed as active pulmonary tuberculosis. Bronchial washings for AFB smear was positive in 32/100 (32%) of cases and post bronchoscopic sputum smear was positive in 16/100 (16%) of cases. Both bronchial washings and post bronchoscopic sputum smear for AFB was positive in 10 (10%) of cases. 4/16 additional cases are diagnosed by post bronchoscopic sputum smear over the bronchial washings. Total yield of bronchoscopy in the diagnosis of sputum negative Pulmonary Tuberculosis was A.N.V. Koteshwar Rao, L. Bhaskar, K. Vamshi, Pradyut Waghray. Yield of AFB by direct sputum smear examination with bronchial washings and post bronchoscopy sputum smear examination. IAIM, 2017; 4(11): 113-116. Page 114 38.00% of which bronchial washing smear samples are superior in the diagnosis and is contributed to 32% . Conclusion: It has shown that additional yield of 38% more than direct sputum smear examination, which helps to initiate early treatment of tuberculosis.

Role of Induced Sputum, Bronchial Aspirate and Post Bronchoscopic Sputum in the Diagnosis of Sputum Smear Negative Pulmonary Tuberculosis.

Background: The diagnosis of Pulmonary Tuberculosis is largely dependent of the positive result of the sputum smear by ZN staining. But in many cases, although active tuberculosis is present, due to many reasons, sputum smear may yield a negative result. With a late culture result, no reliable serological test available to enable an early diagnosis, role of induced sputum and bronchoscopy has been tried with excellent results. Methods: 50 fresh smear negative cases between the ages of 16-65 years, clinically and radiologically suspected of Pulmonary Tuberculosis were subjected to induced sputum and bronchoscopy after detailed history and thorough clinical examination as done. Clinical symptoms were noted, 2 sputum smears (spot and early morning) and chest x-rays were taken for all patients. Results: Males between 24 – 44 years were seen to be predominant patients. The most common symptom appeared to be cough in 80% followed by fever in 60% of the cases. 76% of patients had unilateral lesions and 24% with bilateral lesions. 84% of the sputum negative patents were identified as active tuberculosis cases. Conclusion: Induced sputum and fiber optic bronchoscopy with bronchial aspirate and post bronchoscopic sputum can provide excellent material for diagnosis of suspected cases of Pulmonary Tuberculosis in whom smears of expectorated sputum do not reveal mycobacteria. There is minimum patient discomfort, reduced complications and relatively good yield which makes these procedures justifiable in the diagnosis of fresh smear negative pulmonary tuberculosis.

Detection of Lung Cancer using MAGE A1-6 and SSX4 RT-PCR Expression Profiles in the Bronchial Wash Fluid / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Bronchial wash fluid may be a useful for detecting lung cancer. To increase the detection rates, we performed molecular analysis with using MAGE A1-6 and SSX4 RT-PCR on bronchial wash fluid specimens. MATERIALS AND METHODS: We obtained 57 lung cancer tissue specimens by bronchoscopic biopsy and 131 bronchial washes from 96 patients with lung cancer and 35 patients with benign lung diseases. The MAGE A1-6 and SSX4 gene expressions were investigated in the cancer tissue specimens and bronchial wash fluids. We evaluated the positive detection rates of these methods according to the cytology results and the clinical findings. RESULTS: For the cancer tissue specimens and the bronchial wash fluid, the positive detection rate of MAGE or SSX4 was 91.2% and 75.0%, respectively. Combined MAGE and SSX4 PCR and cytology tests showed an 83.3% detection rate for the bronchial wash fluid. From bronchial washes of patients with benign lung diseases, the positive rates of using MAGE or SSX4 was 11.4%. In the bronchial wash fluid of lung cancer patients, 66.7% of the peripheral cancers were detected by MAGE or SSX4, while examination with cytology did not detect any peripheral lung cancer. CONCLUSION: The application of both MAGE and SSX4 showed high sensitivity and specificity for the detection of lung cancer. Thus, MAGE and SSX4 RT-PCR may be effectively utilized as additional methods to improve detection of lung cancer with using bronchial wash fluids.

Effect of Leukotriene C4 on Glandular Kallikrein Activity in Bronchial Wash of Guinea Pig / 대한마취과학회지

The involvement of plasma kallikrein-kinin system in some pathological states such as bronchial asthma and coughing induced by captopril has been suggested, LTC, and LTD, have been well reported to have a potent activity of bronchoconstriction and mucous secretion. The author tried to confirm whether leukotrienes increase glandular kallikrein activity in bronchial wash or not, and if it is true, to investigate the possible mechanism of leukotrienes-induced increase of glandular kallikrein activity. Bronchial wash was collected from excised lungs of guinea pig, and incubated with synthetic substrate (Pro-Phe-Arg-MCA), and released amount of AMC was measured by fluorescence spectrophotometer as the amidase activity (glandular kallikrein activity). In order to confirm that glandular kallikrein can release kinin, bronchial wash was also incubated with purified LMW- kininogen in the presence of kininase inhibitor (o-phenanthroline), and the amount of kinin was measured by enzyme immunoassay as the kinin releasing activity of glandular kallikrein. The results were as follows: 1) The glandular kallikrein activity (control: 2.98 x 10(-11) mole/min/ml wash) was increased by pilocarpine (12-120 umole/kg, i.v.), and the increased glandular kallikrein activity by pilocarpine (41 nmole/kg, i.v.) was inhibited by atropine (4-43 nmole/kg, i.v.). 2) LTC(4) (1-10 nmole/kg, i.v.) or LTD(4) (1-10 nmole/kg, i.v.) increased the glandular kallikrein activity, but the potency of LTD, was about 1/3 of that of LTC,. The increased glandular kallikrein activity by LTC, (3 nmole/kg, i.v.) was inhibited by ONO-1078 (20-203 nmole/kg, i.p.). 3) The increased glandular kallikrein activity by LTC, (3nmole/kg, i.v.) was inhibited by in- domethacin (8-83 nmole/kg, i.p.), OKY-046 (11-113 nmole/kg, i.v.), atropine (4-43 nmole/kg, i.v.), scopolamine (9-88 umole/kg, i.v.) and Thi-D-Phe-BK (100-1000 nmole/kg, i.v.). 4) STA, (6-60pmole/kg, i.v.) increased the glandular kallikrein activity, and the increased glandular kallikrein activity by STA, (20 pmole/kg, i.v.) was inhibited by atropine (14 umole/kg, i.v.) (p < 0. 001). 5) The increased glandular kallikrein activity by pilocarpine (41 urnole/kg, i.v.) was not inhibited by indomethacin (83 umole/kg, i.p.), but it was inhibited by Thi-D-Phe-BK (300 nmole/kg, i.v.) (p< 0. 001). 6) Bradykinin (3-30 nmole/kg, i.v.) increased the glandular kallikrein activity, and the increased glandular kallikrein activity by bradykinin (30 nmole/kg, i.v.) was inhibited by indomethacin (83 umole/kg, i.p.) or atropine (14 umole/kg, i.v.) (p<0.001). 7) The kinin releasing activity by glandular kallikrein in bronchial wash was 24 x 10 " mole/min/ ml wash in control group, and it was markedly increased in pilocarpine-pretreated group (124 x 10 mole/min/ml wash) (p<0.05), and in LTC4-pretreated group (164x10 mole/min/ml wash) (p<0. 01). The increased kinin releasing activity by LTC, (3 nmole/kg, i.v.) was completely inhibited by aprotinin (5000IU/ml, i.v.). I could conclude that i ) LTC, and LTD, increased glandular kallikrein activity in bronchial wash of guinea pig, ii) the most possible mechanism of LTC,-induced increase of glandular kallikrein activity in bronchial wash may be as follows; LTC,TXA,aeetyleholineinerease of glandular kallikrein acitivity, and iii) kinin released by glandular kallikrein may enhance the action of TXA, or acetylcholine to increase the glandular kallikrein activity.