Extraluminal atherosclerosis: an under-recognised finding in human aortocoronary venous bypass grafts.

BACKGROUND: Coronary artery bypass grafting (CABG) is commonly compromised by graft atherosclerosis. Histopathologic studies confirm various forms of atherosclerosis, including positively remodelled lesions in native coronary arteries but there are no histopathologic reports of extraluminal atherosclerosis in vein grafts. METHODS: We prospectively investigated the histopathologic presence and pattern of extraluminal atherosclerosis in human old vein grafts in a two-year interval among patients undergoing redo-CABG at three university hospitals in Tehran. We separately documented clinical and angiographic findings. RESULTS: We evaluated 100 segments from 20 human old vein grafts obtained during the redo CABG. All but four segments demonstrated some degrees of luminal narrowing. Luminal atherosclerotic plaques were detectable in 61 segments. We detected extraluminal atheroscleoris in seven segments. Mean vessel wall thickness was greater in segments containing extraluminal plaques (1.41±0.26 mm versus 0.91±0.04 mm, P=0.008). Angiographic findings had a modest correlation with presence or absence of luminal atheromatous lesions (Spearman's rho: 0.331, P=0.007). Angiographic degree of stenosis could not predict the presence of positively remodelled atherosclerotic plaques (Spearman's rho: -2.21, P=0.073). CONCLUSION: Previous studies suggested positive remodelling in vein grafts. Out study provides histopathologic evidence on extraluminal atherosclerosis in human aortocoronary vein grafts.

Histopathologic insight into saphenous vein bypass graft disease.

OBJECTIVES: Vein graft disease is a major drawback of coronary artery bypass grafting. However, histopathologic studies of old human aortocoronary grafts are scarce. METHODS: We screened patients undergoing redo coronary artery bypass grafting at three university hospitals and selected those with at least one excisable old vein graft. Native non-grafted saphenous veins were also obtained as controls. Clinical and angiographic data were separately documented. RESULTS: We evaluated 117 segments from 29 veins. All but 4 old graft segments showed degrees of luminal narrowing and fibrointimal proliferation. Moreover, 61 segments demonstrated atherosclerotic plaques. Such plaques were typically concentric and, compared with other segments, more frequently represented necrosis, calcification and giant cells (p < 0.001 for all comparisons) and had a higher inflammatory cell count, predominantly of lymphocytic origin. Native saphenous veins frequently showed fibrosis, but no calcification or active inflammation. Angiographic findings showed moderate correlation with the histological degree of luminal stenosis (Spearman's ρ = 0.564, p < 0.001). CONCLUSIONS: Human vein graft atherosclerosis and arterial atherosclerosis share many features; however, we found lymphocytes to be the dominant inflammatory cells within plaques. Conventional angiography underestimated the atherosclerosis burden in vein grafts. Improved understanding of disease pathophysiology could lead to the development of novel interventions that reduce costly and suboptimal repeat revascularizations.

Characterization of melanoma-associated antigen-a genes family differential expression in non-small-cell lung cancers.

BACKGROUND: The melanoma-associated antigen (MAGE) genes families are found in different cancers, including non-small-cell lung cancers. These genes are silent in normal tissues, except for the testis. The goal of this study was to investigate the differentially expressed profile of the different MAGE genes subclass in non-small-cell lung cancer (NSCLC) tumoral tissue. METHODS: Formalin-fixed paraffin embedded NSCLC resected tissues were collected from 31 patients hospitalized in our referral hospital, and 29 patients were diagnosed with either squamous cell carcinoma (SCC) or adenocarcinoma (ADC). We used a nested reverse transcriptase-polymerase chain reaction, which comprised independent amplification of MAGE-A1, MAGE-A2, MAGE-A3/6, MAGE-A4, and MAGE-A12, to detect expression frequency of the MAGE-A family in lung tissue biopsies at both tumoral and nontumoral parts of patients' tissues. RESULTS: From 29 patients with diagnosis of either SCC (n = 16) or ADCs (n = 13), 58 samples were prepared. From 58 blocks sampled for this experiment, 37 tumoral tissue samples and 22 nontumoral tissue samples expressed at least one of the MAGE-A genes. MAGE-A4 gene had the highest incidence among all MAGE-A genes in both tumoral and nontumoral gens. In SCC and ADCs, the data showed expression of at least one of the MAGE-A genes in 59.4% and 69.2% of tumoral and nontumoral tissues, respectively. CONCLUSION: The detection of the MAGE-A genes expression could be a molecular tumor marker for early diagnosis and potential targets for active immunotherapy in NSCLC, particularly in ADCs and SCC. Besides, the frequency of different subtypes of MAGE genes may vary in different regions of world.

Colorimetric detection of multidrug-resistant or extensively drug-resistant tuberculosis by use of malachite green indicator dye.

The malachite green microtube (MGMT) susceptibility assay was performed directly on sputum specimens (n = 80) and indirectly on Mycobacterium tuberculosis clinical isolates (n = 60). The technique is based on the malachite green dye, which changes color in response to M. tuberculosis growth. The MGMT assay is simple and rapid and does not require expensive instruments.

Comparison of clinicoradiologic manifestation of nonspecific interstitial pneumonia and usual interstitial pneumonia/idiopathic pulmonary fibrosis: a report from NRITLD.

BACKGROUND: Ever since Katzenstein and Fiorelli introduced the term nonspecific interstitial pneumonia (NSIP) to denote those cases of interstitial pneumonia that cannot be categorized as any of the other types of idiopathic interstitial pneumonias (IIP), there has been continuing debate on whether it is a real clinical entity or not. The American Thoracic Society/European Respiratory Symposium task group tried to identify idiopathic NSIP as a separate disease and exclude it from the category of IIP. However, it appears that the clinical presentation of NSIP and usual interstitial pneumonia (UIP) are the same. OBJECTIVE: To show that the radiologic features of NSIP and UIP should be relied upon, instead of clinical presentation and pathologic findings, to differentiate between the two. MATERIALS AND METHODS: Consecutive patients who had received a diagnosis of either NSIP or UIP on the basis of open lung biopsy between January 2001 and December 2007 were identified for inclusion in this retrospective review. The study included 61 subjects: 32 men and 29 women with a mean age of 59.39 +/- 14.5 years. Chest computed tomography images of all the cases were collected for a review. High resolution computed tomography (HRCT) and all pathologic specimens were also evaluated. A weighted kappa coefficient was used to evaluate whether radiology can be used instead of biopsy for the diagnosis of NSIP and UIP. Comparison of the mean ages and the time intervals (i.e., interval between symptom onset and the time of diagnosis) in the UIP and NSIP groups was done using the Mann-Whitney U test. Association between gender and biopsy result was evaluated by the Fisher exact test. Data were evaluated using SPSS, v.13. RESULTS: Sixty-one patients were included in this study, 32 were male and 29 were female. On the basis of biopsy findings, 50 (82%) patients had UIP and 11 (18%) had NSIP. Thirty (60%) of the 50 patients who had UIP were male and 20 (40%) were female; 2 (18.2%) of the 11 patients who suffered from NSIP were male and 9 (81.8%) were female. Based on HRCT findings, 36 (60%) patients were diagnosed to have UIP and 24 (40%) were diagnosed with NSIP. When diagnosis was based on biopsy findings, the time interval in the UIP group was 13.59 +/- 8.29 months and in the NSIP group it was 7.90 +/- 4.18 months. When diagnosed on the basis of HRCT findings, the time interval in the UIP group was 14.22 +/- 8.94 months and in the NSIP group it was 10.54 +/- 5.78 months. When diagnosis was on the basis of biopsy, the mean age in the UIP group was 61.30 +/- 14.18 years and in the NSIP group it was 50.73 +/- 13.14 years. CONCLUSION: HRCT can be used instead of invasive methods like lung biopsy to differentiate between UIP and NSIP.

Prevalence of Haarlem I and Beijing types of Mycobacterium tuberculosis strains in Iranian and Afghan MDR-TB patients.

OBJECTIVES: This survey identified the spoligopatterns of Mycobacterium tuberculosis strains with an international designation responsible for transmission and prevalence of Multi-Drug Resistance Tuberculosis (MDR-TB) among native and immigrant population of Tehran (2000-2005). METHODS: The spacer oligonucleotides typing was performed on 263 M. tuberculosis strains isolated from verified cases of MDR-TB. Clinical and demographical data of patients were collected using traditional methods. RESULTS: Classical epidemiological investigation revealed that out of 263 MDR-TB cases, 175, 66.5% were isolated from Afghan immigrants. In both communities, majority of MDR-TB cases had either previous history of TB (107, 40.6%) or had a close contact (84, 31.9%). By spoligotyping, 27 distinct patterns were observed, 253 clinical isolates were grouped in 17 clusters (62.9%) and 10 isolates displayed an orphan pattern (37%). Based on an international spoligotype database, Haarlem I (85, 33.5%), Beijing (52, 20.5%), Central Asia (32, 12.1%), and EAI (21, 8.3%) were the major identified super families. Although, 76.9% of the Beijing genotypes and 100% of ST(253) strains (that was prevalent through former Soviet Union) were isolated from Afghan patients only. The linkage patterns between 30 Iranian and Afghan patients were observed. CONCLUSION: The study highlighted the epidemic potential of Haarlem I and Beijing genotypes among MDR-TB cases in Tehran territory.

Treatment of multiple drug-resistant tuberculosis (MDR-TB) in Iran.

SETTING: Masih Daneshvari Hospital, Tehran, Iran, 2000-2002. OBJECTIVE: To evaluate the effectiveness of multiple drug-resistant tuberculosis (MDR-TB) treatment for the first time in Iran. DESIGN: All cases of MDR-TB with complete follow-up data were recruited and results of their treatments were evaluated. RESULTS: MDR-TB treatment was initiated with 5.23 drugs, on average. Isoniazid, amikacin, and ofloxacin were present in the drug regimen of all patients. Average duration of the treatment was 18.5 months (range, 7-36). Over 76% of the patients responded to the treatment (negative smear and culture). Cure and probable cure were documented in seven (41.2%) and four (23.5%) of the patients, respectively. No failure in the treatment occurred when cycloserine was present in the treatment regimen. CONCLUSION: A majority of the MDR-TB patients in Iran can be cured with the use of appropriate treatment regimens. An even greater success could be achieved by providing more second-line drugs.

Mycobacterium gastri causing disseminated infection in children of same family.

Two children of the same family were admitted to the pediatric ward with a history of productive cough, nocturnal sweats, and weight loss. On physical examination, lymphadenopathy was seen on both sides of the neck and axillae. The sizes of the lymph nodes varied, and some showed fistula formation with drainage. A chest x-ray of the boy revealed diffuse nodular densities, while in the girl, peribronchial thickening in both lower lung zones and hilar adenopathy were detected. Sonography of the abdomen and pelvis in both cases showed multiple para-aortic adenopathies with hypodense centers. Microscopic examination of sputum, gastric washings, and node biopsy specimens proved positive for acid-fast bacilli. Systematic identification of acid-fast bacilli on Lowenstein-Jensen culture media identified the isolates as Mycobacterium gastri. These appear to be the first cases of pediatric infection and the fourth report of human infection caused by this atypical Mycobacterium.

Bacteriological follow-up of pulmonary tuberculosis treatment: a study with a simple colorimetric assay.

The viability of Mycobacterium tuberculosis (MTB) in serial sputum specimens from persistently smear positive patients was evaluated. The assay was based on oxidation-reduction of Alamar Blue and Malachite Green dyes that change their color in response to MTB growth. A total of 280 sputum specimens from 40 persistently smear positive TB patients and 40 sputa from non-tuberculosis patients were digested, decontaminated and examined microscopically. To check the MTB viability, the sediments from decontaminated samples were inoculated into three culture media: Lowenstein-Jensen (LJ) slants, Alamar Blue and Malachite Green culture tubes. We found that out of 280 smear positive specimens, the LJ culture was positive in 124 (44%). The numbers of correctly identified S+/C+ cases by Alamar Blue and Malachite Green were 118 (95%) and 116 (93%), respectively. The mean time required for reporting the positive signal in Alamar Blue culture tubes was 9 versus 11 days by Malachite Green culture tubes. In the standard LJ culture media the average detection time was 27 days (P < 0.05). The sensitivity of LJ was 99%, Alamar Blue 95% and Malachite Green 93%. The specificity was 100%, 92% and 93%, respectively. The oxidation-reduction method is rapid, sensitive and inexpensive in monitoring the treatment response of patients with pulmonary TB. Thus, using this method can be of paramount importance, particularly in resource-constrained areas.