Predicting culture results for Mycobacterium tuberculosis complex. Amplified mycobacterium tuberculosis direct test and acid-fast bacilli microscopy.

STUDY OBJECTIVE: To evaluate the usefulness of the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (AMTDT; Gen-Probe; San Diego, CA) in predicting the results of cultures in routine laboratory analysis of a patient population with a high incidence of tuberculosis (TB). PATIENTS: Three hundred ten patients suspected of pulmonary mycobacterial infection or receiving antituberculous chemotherapy, accrued between 1996 and 1997. SETTING: Tertiary-care facility located in Northern Italy. DESIGN: We retrospectively compared the AMTDT results with the results of cultures. AMTDT results were also compared with those of acid-fast bacilli (AFB) staining of the same specimens. The study included 360 respiratory specimens from 310 patients collected between 1996 and 1997. In 1996, we used the initial version of AMTDT (50 microL of sediment); in 1997, we used the new version of AMTDT (450 microL of sediment). RESULTS: Compared with cultures, AMTDT and AFB staining had sensitivities of 87.2% and 68.4%, and specificities of 70.0% and 89.7%, respectively. When AMTDT and AFB staining were both positive, the sensitivity and specificity were 89.3% and 96.9%, respectively. When AMTDT and AFB staining were in disagreement, the sensitivity and specificity of AMTDT were 81.8% and 18.1%, respectively. CONCLUSION: We conclude that when AMTDT is used to predict culture outcome, the results should be evaluated in conjunction with AFB staining results before making decisions about TB management.

[Transvaginal echographic evaluation of myometrial invasion in patients with endometrial cancer]. / Valutazione con ecografia transvaginale dell'invasione miometriale in pazienti affette da carcinoma dell'endometrio.

Twenty-one patients with endometrial cancer who underwent laparotomy, were pre-operatively examined by transvaginal sonography. A deep myometrial invasion (> 50%) was noted sonographically in 9 patients (42.3%), with a superficial invasion (< 50%) in 12 (57.2%). A deep invasion was histologically seen in 10 patients (47.6%), with a superficial invasion in 11 (52.4%). In myometrial deep invasion evaluation, transvaginal sonography showed a 90% sensibility, a 73% specificity, a 75% positive predictive value and a 93% negative predictive value. In 3 cases (14.3%) the invasion depth was sonographically overestimated and in 1 case (4.8%) underestimated. These results make possible an important role of transvaginal sonography in staging endometrial cancer, to select patients needing for pelvic and lomboaortic lymphadenectomy over total abdominal hysterectomy with vaginal collar.

Limited diagnostic value of lymphocytic karyotype in primary amenorrhea with streak gonads.

Cytogenetic data represent a first line diagnostic aid in gonadal dysgenesis. Generally, the results of a peripheral blood examination reflect the genotypic alteration of the patient. Nevertheless, on occasion one may encounter cases in which clinical and hormonal evidence suggestive of dysgenesis is not accompanied by an anomalous chromosomal finding, upon cytogenetic analysis of the peripheral blood. In these cases, a cytogenetic alteration may be present in cellular components of the ovary and the cutis. In the light of the above, two patients presenting with primary hypergonadotropic amenorrhea, streak gonads and normal peripheral karyotype are described. In one patient presenting with phenotype alterations, ovarian wedge biopsy via laparotomy followed by cytogenetic analysis of ovarian tissue and tissue from the cutis revealed a 45,X/46,XX-type mosaicism. In the other patient, the ovarian cytogenetic findings were unremarkable. Extending chromosomal analysis to several tissues, beyond the peripheral level, in selected cases, is discussed.

Non-mosaic isodicentric X-chromosome in a patient with secondary amenorrhea.

An isodicentric X-chromosome idic(X) (pter----q26.1::q26.1----pter) was found in lymphocytes and ovarian tissue of a 40-year-old female patient with secondary amenorrhea. No mosaicism was observed. The phenotype-karyotype correlation of our case and of previously described non-mosaic cases of idic(X) (q::q) with different breakpoints is discussed.