[Tuberculous infection in nursing students: prevalence and conversion during a 3-year follow-up]. / Infección tuberculosa en estudiantes de enfermería. Prevalencia y virajes durante 3 años de seguimiento.

BACKGROUND: The aim of this study was to ascertain the positive tuberculin prevalence among the nursing students at the beginning of their studies; to assess the annual tuberculin conversion rate during their studies; to obviate the possibility of false conversions, studying the booster effect. PATIENTS AND METHODS: Cohort study, prospective, 3 groups not parallels (n = 316), 32 months follow-up in all students. Mean age 21 years (SD = 4; range = 17-39). First phase: before beginning clinical practice, a tuberculin test was undertaken by Mantoux technique with PPD type RT-23 with Tween 80 of 2 TU; this was repeated after 7-10 days, to BCG vaccinated and PPD negative on the first one, to study the booster effect. Second phase: at 18 months we repeated the tuberculin test to PPD negatives including the vaccinates with booster effect but PPD negative. The end of the study was at 32 months, repeating the test to PPD negatives at the end of their nursing studies. RESULTS: Tuberculin prevalence of 12% (38/316); CI 95%: 8.4%-15.6%. There were no significant differences of prevalence between vaccinated and unvaccinated nurse students. The prevalence in women was 8.9% (24/267) and 28.6% (14/49) in men. The only variables with statistical significance for being tuberculin positive were, age (p = 0.002) and sex (p = 0.003). 3/42 vaccinated with BCG (7%) had initial PPD (+); 2/39 of the remaining (5%) showed to be tuberculin positive after the booster effect and 37 tuberculin negative and booster negative. In the conversion study there were 259 valid students at the end of 3 years; there were 14 (5.4%) converters in the second year and 9 (3.5%) in the third year. Tuberculin conversion annual rate was 3.8 per 100 people/year. CONCLUSIONS: The tuberculous infection prevalence in nursing students was 12% (38/316). The annual frequency of tuberculin conversion (3.8 per 100 people/year) was higher in our students than in the general population, reinforcing the suitability of making periodical tuberculin control tests in PPD negative student nurses with continuous hospital contact.

Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients.

STUDY OBJECTIVE: To assess tolerance and early results of Dumon silicone stents inserted in patients with nonneoplastic airway obstruction. DESIGN: Tracheobronchial stenting for palliative or curative restoration of airway narrowing has been evaluated in a retrospective study. SETTING: Tertiary-referral teaching hospital. PATIENTS: Between May 1991 and September 1994, 64 patients with a mean age of 52 years had endobronchial silicone stent insertion for benign tracheal stenosis (82% secondary to intubation or tracheostomy injury). Lesions were pure fibrous stenosis in 25 patients and fibroinflammatory stenosis in 38. Prostheses were used for temporary stenting of the airway during 18 months in 48 patients in whom cure was expected and as a procedure for palliation in the remaining 15 patients. INTERVENTIONS: In all cases, the Dumon tracheobronchial stent was implanted with the rigid bronchoscope under general anesthesia. RESULTS: Five patients died (four from unrelated causes); one was due to hypersecretion and airway obstruction at the time of an emergency tracheostomy 20 days after stent insertion. Complications included migration of prostheses in 11 (17.5%) patients, granuloma formation in 4 (6.3%) patients, and airway obstruction due to heavy secretion in 4 (6.3%). In 48 patients who received silicone stents with curative expectations, removal of the device was accomplished in 21 patients. Therapy proved successful in 17 patients with a mean follow-up of 259+/- 173 days and stenosis recurred in 4. In 16 patients, stents still remain for a mean period of 364+/-119 days. In the series of 15 patients in whom silicon stents were implanted for palliation, prostheses were placed permanently in 11 with a mean follow-up of 486+/-260 days. In the remaining four patients with tracheostomy, silicone stents were used after inability to expand the upper limb of the T-tube (two patients) or placed above the tracheostomy stoma to maintain laryngotracheal patency and preserve phonation when a T-tube was poorly tolerated (two patients). CONCLUSIONS: Silicone tracheobronchial stents are effective in the maintenance of airway patency and are associated with good tolerance and infrequent complications that are rarely life-threatening.