Value of different cut-off points of tuberculin skin test to diagnose tuberculosis among patients with respiratory symptoms in a chest clinic.

OBJECTIVE: To assess the utility of various cut-off points of tuberculin skin test in making a diagnosis of tuberculosis in patients with respiratory symptoms. METHODS: Tuberculin skin test was conducted on consecutive new patients attending chest clinic for various respiratory symptoms. All subjects were then investigated to establish diagnosis, and categorized into tuberculous and nontuberculous groups. Receiver operating characteristic (ROC) curve was plotted to evaluate discrimination by tuberculin skin test. Sensitivity, specificity and predictive value were also calculated at various cut-off points. RESULTS: Of 250 patients, 59 (23.6%) had tuberculosis on clinical and microbiological criteria (other than the tuberculin test). Sensitivity and specificity of tuberculin test at readings greater than 5, 10 and 15 mm were 0.8136 and 0.7068, 0.6271 and 0.8901, and 0.2034 and 0.9738 respectively. Area under ROC curve for this test was 0.80. CONCLUSION: A cut-off point of 10 mm is likely to be useful in supporting a diagnosis of tuberculosis in patients with strong clinical suspicion of tuberculosis, in other patients, 15 mm cut-off may be more suitable.

Disseminaçäo pulmonar na laringopapilomatose juvenil / Pulmonary involvement in juvenile laryngeal papilomatosis

Resumo: A laringopapilomatose juvenil é o tumor de trato respiratório mais comum em crianças, porém o acometimentodos brônquios e do parênquima pulmonar ocorre em apenas 1 por cento a 2 por cento dos casos. Os autores relatam um caso de disseminaçäo pulmonar na laringopapilomitose juvenil, descrevendo os aspectos radiológicos e tomográficos das lesöes. Säo feitos comentários sobre abrangência clínica dessa doença e discutidos os aspectos diagnósticos, histopatológicos e terapêuticos provenientes dos dados clínicos relatados no caso e da revisäo de literatura realizada.

Sarcoma de Kaposi broncopulmonar: revisión del tema a propósito de un caso clínico / Bronchial-pulmonary Kaposi's sarcoma: review of the theme a propos of one clinical case

El presente trabajo es la revisión de una entidad clínica poco conocida, como es el sarcoma de Kaposi broncopulmonar, además, se presenta el primer caso diagnosticado en nuestro país. El sarcoma de Kaposi es una neoplasia vascular que se presenta en pacientes inmunodeprimidos. Ha cobrado gran impostancia desde el inicio de la pandemia de la infección por el virus de la inmunodeficiencia humana (VIH). El sarcoma de Kaposi compromete fundamentalmente la piel, pero también puede afectar a una gran variedad de órganos y sistemas, siendo el más frecuente el compromiso broncopulmonar. En esta revisión del sarcoma de Kaposi broncopulmonar, se describe su epidemiología, el cuadro clínico-radiológico, los exámenes complementarios útiles en el diagnóstico y su tratamiento. Además se presenta un caso clínico y el enfoque que el médico debe tener frente a un cuadro de infiltrados pulmonares en un paciente que padece VIH

Biomarkers in chemoprevention for upper aerodigestive tract tumors

A chemopreventive approach to cancers of the upper aerodigestive tract (including those of head and neck and lung) to reduce the incidence and mortality rates for these cancers has become an important strategy because therapies such as surgery, radiation, and chemotherapy have only marginally improved the five-year survival rate over the last two decades. However, chemopreventive trials have been hampered by serious feasibility problems, including high cost, the requirement of large numbers of patients, and long-term follow-up necessary to determine cancer incidence, which served as the study end point. Thus, the use of biomarkers, the identification of which would serve as an intermediate end point of the study has recently emerged as a subject of great interest. To try to understand the process of tumorigenesis from normal tissues through the premalignant tissue stage to malignant lesions, there has recently been a search for genetic and/or phenotypic changes that qualify as candidates for biomarkers. These candidates include genomic markers, certain specific genetic markers (such as oncogenes, growth factors and their receptors, and tumor suppressor genes), cell proliferation markers, and cell differentiation markers. This review covers genomic markers (including micronuclei and specific chromosomal alterations) and specific genetic markers (such as the ras gene family, the myc family, erb B1, int-2/hst-1, and the p53 tumor suppressor gene). As a consequence of genetic alteration, we also reviewed cell proliferation markers such as proliferating cell nuclei antigen (PCNA) and the squamous cell differentiations markers, including keratins, involucrin, and transglutaminase 1. These biomarker candidates are important adjuncts to the development of the new chemopreventive agents and to the rational design of future intervention trials. However, it should be emphasized that these biomarkers must first be validated in clinical trials; only then can they replace cancer incidence as the sole end point in chemoprevention trials.