[Routine direct detection of Mycobacterium tuberculosis with a rapid test of polymerase chain reaction applied to a Hungarian patient population]. / A Mycobacterium tuberculosis komplex direkt kimutatására szolgáló polimeráz láncreakción alapuló gyorsteszt rutinszerú alkalmazása magyarországi betegpopuláción.

The results of the present study, based on 1869 examined clinical specimens of 543 patients, represent the Hungarian parameters of a PCR test. By using the final and resolved results, the clinical sensitivity, specificity, positive and negative predictive values were 83.8%, 99.2%, 95.4% and 97%, respectively for PCR, 63.5%, 100%, 100% and 93.5%, respectively for culture, and 16.2%, 100%, 100% and 86.3%, respectively for Ziehl-Neelsen (ZN) staining. These results are essential to allow Hungarian clinicians to interpret PCR results in accordance with local conditions. The present study has demonstrated a high sensitivity (PCR vs. culture and smear, p < 0.01) and an excellent specificity of PCR. Our results indicate that the majority of M. tuberculosis-positive specimens can be identified rapidly with the test and, because of the high negative predictive value, the PCR test can help to exclude tuberculosis from the differential diagnosis in 24 hours. Moreover, the PCR can detect the presence of M. tuberculosis in 66.6% of ZN-negative and subsequently culture-positive specimens at the time of admission. The results of PCR must be interpreted with extreme caution, and the procedure is recommended only for laboratories, which simultaneously perform culture and microscopy for control of the performance of PCR tests.

[Tuberculosis at the threshold of the 21st century]. / Tuberkulózis a XXI. század küszöbén.

The author summarizes the most important results of the present history of tuberculosis obtained both in Hungary and abroad. He deals with the state of the art of the tuberculosis epidemics all over the world and in Hungary, presenting also the potential genetic risks. He also discusses the risk groups with special regard to the extremely large regional differences, searching for the underlying causes, as well as to that of the relationships between the epidemic and the social factors. He reviews the up-to-date methods of the diagnostics of Mycobacterium tuberculosis. He evaluates the significance of mass screening in the early diagnosis of tuberculosis and lung cancer in Hungary. He gives an overview of the current strategy of treatment, of the principals of directly observed therapy short course (DOTS) and the international results obtained. In the Hungarian surveillance programme, these principles are adapted under domestic conditions. Based on the data from Hungary and abroad, he presents the risk of development of multidrug-resistant strains and the mechanism of their development, presuming that genetic methods will also play a role in the future management of tuberculosis.

[BCG vaccination]. / A BCG-oltásról.

The author expounds the fairly obscure history of BCG vaccination. Summarises the efficiency of accomplished vaccinations of different geographical areas. He accounts the diversity of results by the distinction of technical and methodical conditions and disparity in virulence of BCG strains. Overviews the Inland and European routine and the risk of possible complications. The favourable position of domestic childhood tuberculosis is due to the effective preventive arrangements. Considering the international and national epidemiology of tuberculosis in adults the administration of BCG vaccine, by chance in modified form, is recommended further on.

[Immunomodulation therapy in chronic bronchitis (multicenter study)]. / Immunmodulációs terápia idült hörghurutban (multicentrikus vizsgálat).

(A multicentre clinical trial) The authors treated 120 patients showing the symptoms of chronic bronchitis with BV or placebo for 6 months during the winter period of 1992-93 in a multicentre double-blind clinical trial. The status of the patients was evaluated monthly and the data were analyzed at an independent computer company. The clinical symptoms were significantly milder in the BV group as compared with the placebo group and antibiotics consumption in the BV group was almost half of that recorded in the placebo group. These findings confirm that BV can be effective in the prophylaxis of the exacerbation of chronic bronchitis.

The protective effect of N-acetyl-aspartyl-glutamate (NAAGA) against nasal obstruction provoked by antigen in allergic rhinitis.

Specific nasal challenge test (NCT) with pollen extracts was performed before and after a single dose pretreatment with N-acetyl-aspartyl-glutamate (NAAGA: Rhinaaxia) nasal spray in 11 grass- and ragweed-pollen-sensitive patients with allergic rhinitis in symptom-free condition to test the protective effect of this drug on allergen-induced nasal obstruction and symptoms. In 7 of 11 patients, a third NCT was performed in the same way as the second one, except that placebo spray was used for pretreatment instead of NAAGA nasal spray. Nasal airways resistance (Rnas) measurements were performed before pretreatment and 15 min after NCT. Pretreatment with NAAGA 1 h before NCT significantly (P < 0.001) attenuated antigen-induced nasal obstruction. The mean protection was 64%. The protective effect against nasal symptoms was likewise significant (P < 0.001), but the mean protection was found to be essentially lower (39%) than for Rnas. Pretreatment with placebo nasal spray showed only a 13% (P > 0.1) protection for Rnas, while it did not decrease allergen-induced nasal symptoms. The results suggest that the favorable effect of the regular administration of NAAGA in allergic rhinitis is to be expected primarily when the main complaint is nasal obstruction.

[Value of computer tomography in the diagnosis of lung hamartomas]. / A computer tomographia jelentösége a tüdö hamartomák diagnosztikájában.

Detailed radiological examinations were undertaken in six cases of hamartochondromas verified by histopathology on surgical samples. It has been shown that examination of lung hamartochondromas by computer tomography provides a good approach for separation of different tissues constructing hamartochondromas. Thus cartilage, lose and dense and mixed forms of connective tissue, and adipose tissue can be well separated. The growth rate of hamartochondromas is very slow, characterized by doubling times of several hundred to several thousand hours.

[Electron microscopic structure of mastocytes of the airways and changes in the clinical status during steroid inhalation therapy]. / A légúti mastocyták elektronmikroszkópos szerkezete és a klinikai állapot változása inhalációs steroid kezelés alatt.

The structure of epithelial mast cells obtained by bronchial biopsy from asthmatic patients reveals characteristic qualitative and quantitative features. Great amount of partly or completely depleted mast cells can be observed in active asthmatic patients, indicating the liberation of bronchoconstrictive mediators. After a two months treatment with inhalative steroid (budesonide) the process of degranulation slows down, the number of depleted mast cells decreases. Parallel with the above described phenomenon, the number of dyspneic attacks, as well as the necessity of other antiasthmatic drugs show a significant decrease. However, in this patient material, during the treatment period, airway hyperreactivity, detected by bronchial provocation, failed to show any remarkable change.

[Fatigue of the respiratory muscle and respiratory insufficiency]. / A légzöizom elfáradása és a légzési elégtelenség.

Recent results on respiratory muscle function are reviewed, with special regard to the muscle fatigue theory of respiratory failure. In this respect diagnostic measures and clinical symptoms are reported. Therapy is directed to reduce the work of respiratory muscles and temporarily rest them. Within this special role is given to the treatment with respirator and positive pressure breathing.

[Social problems associated with chronic bronchitis]. / Soziale Probleme in Zusammenhang mit chronischer Bronchitis.

The relationships between schooling, occupation, symptoms of chronic bronchitis and smoking habits were investigated in 5,000 people. This study was done in conjunction with a mass X-ray screening effort in a district of Budapest. The number of smokers among those with an academic education was 6-7% lower than in the group with primary school education. Symptoms of bronchitis are less common among the smokers in the former group (7%) than among those in the latter group (18%). The incidence of bronchitis was also lower among intellectuals. It is assumed that higher education or a higher cultural level is associated with a healthier and more modern life style, cigarette smoking being only one, albeit the most important, factor involved.

Successes and failures in the treatment of bronchial asthma.

In the past decade a spectacular development could be observed in the field of antiasthmatic drugs. Though the new drugs did not produce radical change but they created a wide range of treatment possibilities. This paper is dealing with three, probably most rapidly developing fields of asthma therapy. 1. Immunotherapy. The most important allergens could be isolated in a high purity with up-to-date chemical analitical methods. This affords possibility for a more reliable determination of individual sensitivity and desensitizing treatment. 2. Mediator release blocking drugs. While common antiasthmatic medicaments try to counterbalance the effect of chemical mediators released by antigen-antibody reaction, the former partly block mediator release but also decrease bronchial hyperreactivity characteristic of asthma. 3. Glucocorticosteroids. Recent halogenized steroid preparations did not diminish the risk of severe side effects. Their application is limited in time, they are used mainly for the prevention and treatment of asthmatic crisis. Among aerosolized steroids, preparations considered as optimal have local effect but they are slightly absorbed from the mucous membrane. In spite of the new drugs, medication depending on individual sensitivity, actual complaints and lung function values is essential, the asthmatic needs continuous care based on symptoms, complaints.

Presence of covalently bound energy-rich phosphates in human tracheal smooth muscle myosin.

In a preliminary report, the tracheal NaCl-myosin prepared from an old and a young subject was discussed. In the present paper, the total bound phosphate (P) content and its distribution is described in two parallel preparations of human muscle myosin. It was shown that a considerable amount of covalently bound P was present not only in NaCl, but in the fresh preparations of tracheal KCl-myosin. Analysing this phosphate fraction in the alkaline hydrolysate of RNA- and lipid-free preparations of myosin it was confirmed that phosphate was linked to the basic amino acid residues and their hydrolytic derivatives. As the phosphoryl binding sites are partly saturated, the phosphate concentration can be enhanced nearly three-fold compared to the fresh preparation. Phosphate incorporation is an autophosphorylation process depending on the ATP and Mg2+ concentration. Studying the actomyosin fraction in the presence of ATP it was found that its phosphate content can also be increased to a certain degree. It is supposed that the changes in phosphate content of myosin are associated with the formation of crossbridges between the actin and myosin filaments in the processes of muscle contraction and relaxation. The process can be influenced directly and indirectly by some natural factors and drugs resulting in the concentration or relaxation of bronchial muscles.

Species dependent relaxation of intrapulmonary arteries (IPA) of rabbits, dogs and humans by prostacyclin.

Helically cut strips of successive IPA segments of rabbits, dogs and human patients were set up for isometric recording in vitro. High tone was produced by norepinephrine (NE, 3 microM). This tone was markedly reduced by prostacyclin (PGI2) in the secondary, tertiary and quaternary branches of human and canine pulmonary trunk. The IC50 values for PGI2 ranged from 22 to 503 nM, the human vessels being more sensitive to prostacyclin than canine IPA. Under these conditions, the primary and secondary branches of the rabbit pulmonary trunk were not relaxed by PGI2. The contractile potency of NE was determined in each pulmonary vessel studied. The secondary segments of rabbit IPA were about ten times as sensitive to NE (EC50 for NE: 38 +/- 7 nM) as compared to the secondary IPA from dogs and humans (EC50 values: 370 +/- 84 and 440 +/- 50, respectively). When high tone was induced by equieffective contractile concentrations of NE (3 microM for canine and human IPA and 0.3 microM for rabbit vessels), PGI2 was still less effective (P less than 0.01) in relaxing secondary IPA of rabbits (IC25: 220 +/- 55) than the corresponding segments of dogs and humans (IC25: 51 +/- 12 and 17 +/- 4, respectively). The difference between canine and human vessels was also significant (P less than 0.02). These results indicate that there is an interspecies difference in the sensitivity of IPA to NE and PGI2.

Preparation and purification of myosin from human tracheal smooth muscle.

NaCl myosin was prepared from the annular smooth muscles of human bronchus. About 7 mg of gel filtered myosin was gained from 8 g minced tracheal muscle of the younger subject. The yield from the older (74-year old) subject was only 30% of that from the younger subject, even though the starting material was more (12 g minced tissue). Tracheal myosin contains P lipid in considerable amount; P lipids account for some 28% of the total phosphate content of the myosin, and even more (50-55%) in the case of the older subject. The preparation could be phosphorylated only in the presence of CAMP and PGF2 alpha, respectively. Cu2+ treatment liberated less phosphate when compared with myosin preparations from other smooth muscles; however, the majority of the phosphate bonds underwent hydrolysis upon the effect of KOH. The reactions specific for amino acids, and also other observations allow the conclusion that the majority of covalently bound phosphate is present in an ester-type bond. Lysine-vasopressin, and also diethylpyrocarbonate successfully protect the P content of myosin from the hydrolysis inherent to incubation.