[Intestinal tuberculosis]. / Intestinal tuberkulose.

Since the symptoms and clinical presentation of intestinal tuberculosis is nonspecific, the diagnosis is frequently delayed and may be achieved at autopsy only. Intestinal tuberculosis is very rare in Denmark, but may now be seen more often because of increasing numbers of immigrants from countries of the third world with a high prevalence of tuberculosis. A case of intestinal tuberculosis in a 28 year old Somalian female is reported. Methods of diagnosing intestinal tuberculosis are commented, and the frequent necessity of starting medical treatment before a bacteriological diagnosis is reached is emphasized.

[Diagnostic procedures in artificially ventilated patients with pneumonia]. / Diagnostiske procedurer hos respiratorpatienter med pneumoni.

Pneumonia is a common complication in patients requiring mechanical ventilation and the mortality is high. The diagnosis is difficult to establish in spite of many available diagnostic techniques: Aspiration from endotracheal tube or tracheostomy, fiberbronchoscopy with bronchial aspiration, protected specimen-brush (PSB), bronchoalveolar lavage (BAL), transbronchial biopsy or percutaneous lung needle aspiration or open lung biopsy. A review of the literature is given. It is concluded that PSB and BAL combined with quantitative cultures are valid tools, but there is no conclusion as to the superiority of one over the other. With the use of prior antibiotics the rate of false negatives increases and the specificity and sensitivity are lowered. However, we do need a prospective, randomized trial in order to demonstrate that invasive methods in fact decrease morbidity and mortality in the patients compared with clinical judgement alone.

[DNA-fingerprinting and tuberculosis]. / DNA-fingerprinting og tuberkulose.

DNA-fingerprinting or RFLP (Restriction Fragment Length Polymorphism) is a molecular biological technique which allows differentiation between tuberculosis strains. The technique is based on the occurrence of repetitive elements in the mycobacterial genome and is a powerful tool in epidemiological studies. DNA-fingerprinting is also of value in tracking the spread of infection in patients with tuberculosis. The latter is illustrated in two case stories.

[Lymphangioleiomyomatosis]. / Lymphangioleiomyomatosis.

Lymphangioleiomyomatosis (LAM) is a rare disease, which only affects women of childbearing age. A case of LAM in a 36-year-old woman is presented. Patho-anatomical findings are smooth muscle hyperplasia leading to obstruction of lymphatics (possibly resulting in chylothorax), blood vessels (possibly resulting in haemoptysis) and bronchi (possibly resulting in emphysema and pneumothorax). High resolution computed tomography (HRCT) of the chest can show the typical multiple small cysts and bullous emphysema distributed diffusely throughout both lungs together with interstitial fibrosis. Treatment of the disease aims at an inhibition of the presumed growth-promoting effect of oestrogen on the smooth muscle cells. However, progression is often seen in spite of treatment.

[Captopril-induced toxic hepatitis]. / Captoprilinduceret toksisk hepatitis.

Captopril, the competitive inhibitor of angiotensin-converting enzyme, has proved efficient in the treatment of arterial hypertension and heart failure. Its use is generally associated with low incidence of adverse reactions and hepatic injury has not been emphasized as an important adverse reaction in Denmark. However worldwide, several cases of hepatic injury have been reported. We report one case of Captopril-induced hepatic injury. Despite discontinuation of Captopril a hepatorenal syndrome developed and the patient died five weeks after admission. This report emphasizes the need to be aware of the possibility of hepatic injury in patients receiving Captopril.

[Patients' knowledge about their own medication--does verbal information help? A blind, randomized study]. / Patienters viden om egen medicin--hjaelper mundtlig information? En blindet, randomiseret undersøgelse.

Patient's knowledge about their own medicine is often insufficient, and this is possibly a contributory factor for noncompliance. We interviewed 65 patients (median age 61 years) from an out-patient clinic with free access and 86 patients (median age 68 years) from a hospital outpatient clinic. In both groups, knowledge about the dosage and the adverse effects of the drugs was poor. Old age and polypharmacy were associated with poor knowledge; there were no differences as regards knowledge between the two out-patient clinics. The 86 patients from the hospitals out-patient clinic were randomised to either 30 minutes of extended verbal information or to the standard information of the department. At the subsequent visit eight weeks later, a repeated interview indicated, that the informed group had generally improved knowledge about their own medication, while this was not the case in the control group. A statistically significant difference between the groups was, however, only found for medication knowledge about side effects. It is concluded that out-patients knowledge about their own medication is often poor, but can be improved by verbal information.

[Respiratory tract infection and acute deterioration of obstructive lung disease]. / Luftvejsinfektion og akut forvaerring i obstruktive lungesygdomme.

Respiratory infection may aggravate chronic obstructive pulmonary disease. Viral respiratory infections may aggravate asthma, particularly in young individuals. Respiratory Syncytial virus and Rhinovirus dominate in children while, in adults, Influenza or Rhinovirus infections are most frequently concerned. Viral respiratory infections may also cause exacerbation of chronic bronchitis. Bacteria and their products scarcely play any part in asthmatic disease but may possibly aggravate chronic bronchitis and other forms of obstructive respiratory disease. In particular, Haemophilus influenzae and Streptococcus pneumoniae and bacterial endotoxin appear to be of significance. The mechanisms of the effects of viruses have several points of attack: Destruction of epithelium, release of mediators, potentiation of mediator-release and reduced beta-adrenergic function. Bacteria and their products may, similarly, cause bronchoconstriction and may, in vitro, release mediators and potentiate release of mediators.