ABSTRACT
BACKGROUND: In the Netherlands the incidence of tuberculosis (TB) has increased during the last decade. Growing immigration and international travel were important determining factors. To determine if this has resulted in altered clinical manifestations of the disease, we assessed the clinical spectrum of all TB cases diagnosed at our hospital in the period 1994 to 2000. METHODS: All culture-proven TB cases during the study period were retrospectively reviewed for clinical and demographic data. RESULTS: Sixty-five patients were identified. Solitary pulmonary TB was diagnosed in 33.9%, extrapulmonary TB in 51.8% and combined pulmonary and extrapulmonary TB in 14.3% of all cases. Patients were of foreign descent in 78.6% of all cases. Incidence peaked between 15 to 45 years. Decreased immunity was an important determining factor in the older patients. Presenting symptoms were mostly aspecific causing an important doctor's delay in establishing the diagnosis in 25%. Mortality was 3.6% and isoniazid resistance 3.6% CONCLUSIONS: Our data suggest an increase in the percentage of extrapulmonary TB concomitantly with an increasing percentage of patients of foreign descent. Because of aspecific presenting symptoms, TB was often diagnosed late. Treatment is mainly hindered by non-compliance and a high index of suspicion is necessary in making the diagnosis.
Subject(s)
Mycobacterium tuberculosis/isolation & purification , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Antitubercular Agents/administration & dosage , Cohort Studies , Female , Hospitals, Teaching , Humans , Incidence , Male , Middle Aged , Netherlands/epidemiology , Prognosis , Retrospective Studies , Risk Factors , Sex Distribution , Treatment Outcome , Tuberculosis/drug therapy , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/epidemiologyABSTRACT
A 69-year-old woman was hospitalized because of a left-sided pneumothorax due to chronic obstructive pulmonary disease. During chest tube placement she developed hypotension and a decrease in peripheral oxygen saturation. A diagnosis of heart tamponade was made and the patient was treated successfully with pericardiocentesis and placement of a pericardial drain. Cardiac tamponade following chest tube placement is a rare and serious complication. When the clinical condition deteriorates following chest tube insertion, cardiac tamponade should be considered.
Subject(s)
Cardiac Tamponade/etiology , Chest Tubes/adverse effects , Aged , Cardiac Tamponade/diagnostic imaging , Echocardiography, Transesophageal , Female , Humans , Pneumothorax/etiology , Pneumothorax/therapy , Pulmonary Disease, Chronic Obstructive/complications , Treatment OutcomeABSTRACT
We report a patient with bronchial asthma who presented with pneumomediastinum, pneumopericardium, pneumoretroperitoneum, pneumorrhachis and extensive subcutaneous emphysema, after a period of coughing. Pathogenesis, diagnostic procedures and treatment of pneumomediastinum and its complications are discussed.
Subject(s)
Asthma/complications , Mediastinal Emphysema/etiology , Pneumopericardium/etiology , Retropneumoperitoneum/etiology , Subcutaneous Emphysema/etiology , Adult , Cough/complications , Disease-Free Survival , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/therapy , Pneumopericardium/diagnostic imaging , Pneumopericardium/therapy , Retropneumoperitoneum/diagnostic imaging , Retropneumoperitoneum/therapy , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/therapy , Tomography, X-Ray ComputedABSTRACT
We have investigated the effects of inflammatory mediators and beta-adrenoceptor agonists on the adenylyl cyclase responsiveness in alveolar macrophages from control subjects, patients suffering from chronic obstructive pulmonary disease (COPD) and asthmatics. Basal cyclic AMP (cAMP) levels in alveolar macrophages from COPD patients were significantly elevated (plus 42%) as compared to controls. In addition, the adenylyl cyclase responsiveness to prostaglandin E2, histamine and the beta-adrenoceptor agonist salbutamol was significantly impaired in alveolar macrophages from COPD patients and asthmatics. The lipid mediator platelet activating factor showed no effect on cAMP production in all three alveolar macrophage populations. Furthermore, the cAMP-enhancing effects of isoprenaline, salbutamol and histamine appeared to be mediated via beta 2-adrenoceptors and histamine H2-receptor subtypes respectively. Taken together, these data suggest an intrinsic desensitization phenomenon in alveolar macrophages from COPD patients and asthmatics.
Subject(s)
Adenylyl Cyclases/metabolism , Cyclic AMP/biosynthesis , Macrophages, Alveolar/drug effects , Macrophages, Alveolar/enzymology , Adrenergic beta-Agonists/pharmacology , Adult , Aged , Albuterol/pharmacology , Asthma/enzymology , Asthma/pathology , Dinoprostone/pharmacology , Female , Histamine/pharmacology , Humans , Isoproterenol/pharmacology , Lung Diseases, Obstructive/enzymology , Lung Diseases, Obstructive/pathology , Macrophages, Alveolar/chemistry , Male , Middle Aged , Platelet Activating Factor/pharmacology , SmokingABSTRACT
A patient with pulmonary emphysema is described, who had a very low alpha 1-antitrypsin serum concentration (2% of normal). After isoelectric focusing and staining, the patient's serum revealed no visible alpha 1-antitrypsin bands. Immunofixation, following isoelectric focusing, gave a banding pattern identical to that of a normal M type. The existence of this deficient M-allele was confirmed by family studies. Low alpha 1-antitrypsin concentrations, due to the presence of the deficient allele, were coupled with low serum antitrypsin activities.
