Fungal septicaemia in patients with cystic fibrosis associated with totally implantable venous access device system.

Fungal septicaemia is a serious and potentially fatal condition. We report 4 cases in patients with Cystic Fibrosis (CF) associated with totally implantable venous access device system (TIVADS).

Wegener's granulomatosis involving prostate.

We report a rare case of Wegener's granulomatosis involving the prostate in a 28-year-old man. The initial medical treatment was effective, but surgical intervention was required to manage late complications.

Segmental pulmonary veno-occlusive disease secondary to lung cancer.

This report describes two cases of segmental pulmonary vein occlusion secondary to lung malignancy in which lung biopsies showed histological features of veno-occlusive disease. These are the first cases to be reported in the literature in which such lung parenchymal histological changes are described in association with lung malignancy.

An outbreak of tuberculosis in the South West of England related to a public house.

There had been a continuous decline in Mycobacterium tuberculosis infection (TB) during the last century until the trend plateaued in the mid-1980's and started to increase in the early 1990's in the United Kingdom (UK). In England and Wales the incidence of TB has increased by 11% between 1993 and 1998 with an overall incidence equal to 10.9/100,000 population. In the South West (SW) of England the incidence of TB is less than the UK average (4.6/100,000). We report an outbreak of TB in the SW of England which was based around a local public house. Sixteen patients received treatment and thirteen received chemo-prophylaxis. Using a rapid IS6 110- based PCR and Restricted Fragment Length Polymorphism Method, all mycobacteria isolated were shown to be identical, and all cultures were sensitive to the usual anti-mycobacterial drugs. All patients were white Caucasians and none were from high risk groups. Despite the absence of conventional close household contacts a significant number of secondary cases were detected. Possible links between TB cases should be considered even in areas of low prevalence.

Attitudes of 100 patients with chronic obstructive pulmonary disease to artificial ventilation and cardiopulmonary resuscitation.

UNLABELLED: One hundred clinically stable outpatients with chronic obstructive pulmonary disease were surveyed at home by respiratory nurse specialists (RNS) about their views towards cardiopulmonary resuscitation (CPR) and in hospital ventilation. Written information about COPD, CPR and ventilation was provided and consent obtained. The breathing problem-based quality-of-life questionnaire (BP-QoL) was completed. The following information was recorded: age, sex, spirometry, hospital admissions, and antidepressant and oxygen usage in the previous year. Patients were then asked to imagine a scenario in which they were admitted to hospital and their chest condition deteriorated in spite of standard treatment. 'Having reached that stage would you wish to have noninvasive ventilation (NIV), invasive ventilation (IV) or CPR?' Three months later patients were asked to complete a postal patient satisfaction questionnaire. RESULTS: Of 100 patients 41 were male and the mean age was 74.1 years. Fifty four patients had a FEV1 <40% and 37 had a FEV1 between 40 and 59% predicted. Twenty-four patients were on long-term oxygen therapy, eight had taken antidepressants and 56 had been admitted to hospital in the previous year. Forty-eight patients wanted all additional treatments to be attempted if needed and 12 wanted none. Nineteen patients said 'no' for CPR and 10 said 'no' for CPR and IV. There was no significant statistical difference between the groups answering 'yes' or 'no'. Seventy-six per cent of patient satisfaction questionnaires were returned. All patients were satisfied with the way they had been approached and the information received, and 98% of them thought that this issue should be discussed with all patients. CONCLUSION: Attitudes towards resuscitation can be discussed with COPD patients by RNS without causing distress. Attitudes to resuscitation could not be predicted from parameters of respiratory disease severity or age.

Cytological examination of the whole endobronchial brush in bronchoscopic diagnosis of lung cancer.

The combination of cytological and histological techniques has significantly increased the accuracy of fibreoptic bronchoscopy (FOB) in the diagnosis of lung cancer. We tested the hypothesis that cytological examination of material obtained from the whole endobronchial brush might increase the diagnostic yield in patients where conventional brush specimens were negative. Fifty patients who had undergone FOB for suspected lung cancer were studied prospectively. Bronchial lavage, bronchial biopsy and conventional brushing were performed. The whole endobronchial brush was then cut off the end of its wire and transported in a universal pot containing Shandon cytospin collection fluid. The material was dislodged from the whole brush using a vortex and the remaining fluid was centrifuged at 2,000 r.p.m. The fluid concentrate was used to maketwo cytopsin preparations. Papanicolaou stain was used. Fifty patients were studied, of which thirty-nine (78%) had endoscopicaly visible tumour. Of those, bronchial biopsy conventional brushing lavage and whole brush were positive for malignant cells in 31 (79.4%), 29 (74.3%), 21 (53.8%), and 16 (41%) of cases, respectively. A diagnosis of lung cancer was confirmed in 35 (89.7%) cases of endoscopicaly visible tumour. Conventional brushing was positive in two out of 11 (18.2%) cases with no visible tumour. Whole brush analysis was not positive in any of the cases with negative conventional brushings and was the least sensitive test in detecting malignancy Whole endobronchial brush analysis has no advantage in bronchoscopic diagnosis of patients with suspected lung cancer.