Usefulness of transtracheal puncture and aspiration in the bacteriological diagnosis of pulmonary tuberculosis.

Transtracheal puncture enables two samples of bronchial secretions to be taken-the product of transtracheal aspiration and simultaneously expectorated sputum (obtained in 71% of the cases)-for the purpose of testing for Mycobacterium tuberculosis in cases of suspected pulmonary tuberculosis. Two groups of patients were studied: Group I: 100 patients who were poor expectorators and who all underwent transtracheal puncture; Group II (Control): 100 patients who expectorated well or who had been given gastric lavages immediately on admission. Laboratroy analyses revealed M. tuberculosis in at least one of the samples obtained from each of the 200 patients. The authors compare the efficiency of the methods used within each group and between the two groups. Samples obtained by transtracheal aspiration and simultaneous expectoration (75% of positive results) more often contained M. tuberculosis than the other Group I samples (64% of total positive results; 64% of positive results for spontaneous sputa, 65% for gastric fluids), and as often as the Group II samples (76% of total positive results), particularly the expectoration samples (78% of positive results). Simultaneously expectorated sputum more frequently contained M. tuberculosis (82% of positive results) than transtracheal aspiration (69% of positive results). Transtracheal puncture and/or simultaneous expectoration were the only examinations revealing M. tuberculosis in 34 patients in Group I. Non-specific bacteriological findings are not relevant. However, the authors point out that this technique is not always innocuous (although no serious complications were observed in this series), and that transtracheal puncture must always be carried out by physicians trained in the technique.

Live attenuated influenza virus vaccines in patients with chronic broncho-pulmonary diseases. Clinical and immunological evaluation.

The safety and potency of two live attenuated influenza A virus vaccines, administered intranasally, were tested in outpatients suffering from chronic obstructive lung disease, during two successive trials performed between 1972 and 1974. The vaccine strains were representative of the prevalent influenza A virus types; the Ann strain was derived from a classical H3N2 (A/Hong-Kong/878/69) isolated and the Alice strain from a recent H3N2 drift (A/England/42/72). The serum and nasal antibody responses were studied in a total of 40 vaccinees. When a sufficient virus dose was administered, the hemagglutination-inhibition (HI) seroconversion rate was, respectively, 86 and 73% for each vaccine trial in patients with low (less than or equal to 32) prevaccination antibody titers. A booster effect was also observed in some subjects with higher prevaccination titers. In the two trials, clear-cut rises in local antibody activity, as tested in nasal washings' samples were found in, respectively, 92 and 75% of the patients devoid of initial titer before vaccination and in 40 and 37%, respectively, of the subjects having low prevaccination titers. Clinical symptoms were observed in 29% of the cases; they were, however, mild and transient and their occurrence was not necessarily related to the vaccination. Two administrations of intranasal attenuated virus appear therefore to be safe and to lead to a satisfactory antibody response in this "high risk" group of patients.

Pulmonary infections after kidney transplantation.

Seventy-five pulmonary infections out of 173 kidney transplantations have been observed in 62 graft-recipients, from 1965 to 1973. The aetiologic organism is a bacteria in 80% of the cases, a fungus in 8% of the cases, cytomegalovirus and Pneumocystis Carinii in 11% of the cases. A close relationship between infection and a previous transplant crisis was noted in 66% of the cases. The most efficient diagnostic procedures were pleural and open lung biopsy as well as cultures of blood, pleural fluid and tracheobronchial secretions. Treatment was effective in 60% of bacterial and Pneumocystitis Carinii infections; on the other hand, it was less useful in fungal infections and totally ineffective in cytomegalovirus infections. Despite a possible increase in the risk of rejection, reduction or even arrest of immunosuppressive therapy is recommended in severe infections.

Pleural effusion with pancreaticopleural fistula.

Three patients with pleural effusion were found to have pancreaticopleural fistulas passing through an opening in the diaphragm are reported. In one case the effusion was purulent and originated from an abscess of the pancreas. Retrograde pancreatography during operation defined the course of the fistula. In two other cases the fistula was demonstrated by radiography after intrapleural injection of contrast medium. The diagnostic importance of injecting contrast medium early into the pleural cavity in cases of effusion rich in amylase, before lung expansion obscures the fistula, is emphasized. Cases of pancreaticopleural fistula may be commoner than supposed.