[Efficacy and safety of percutaneous transluminal pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension].

Objective: To explore the efficacy and safety of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: This prospective single arm study included 19 CTEPH patients (7 male, age(56.3±12.5)years) admitted to Wuhan Asia Heart Hospital from January 2017 to June 2019 and received PTPA interventional therapy. Baseline data, including age, sex, WHO functional class, 6-minute walk distance (6MWD), NT-proBNP, right heart catheterization values, were collected. Patients received single or repeated PTPA. Number of dilated vessels from each patient was analyzed, patients were followed up for 24 weeks and right heart catheterization was repeated at 24 weeks post initial PTPA. All-cause death, perioperative complications, and reperfusion pulmonary edema were reported. WHO functional class, 6MWD, NT-proBNP, right heart catheterization values were compared between baseline and at 24 weeks follow up. Results: Nineteen CTEPH patients received a total of 56 PTPA treatments. The pulmonary artery pressure (mPAP) decreased from (40.11±7.55) mmHg (1 mmHg=0.133 kPa) to (27.53±4.75) mmHg (P<0.001), and the total pulmonary resistance (TPR) decreased from (13.00±3.56) Wood U to (5.48±1.56) Wood U (P<0.001), cardiac output increased from (3.19±0.63) L/min to (5.23±0.94) L/minutes (P<0.01) at 24 weeks post PTPA. The WHO functional class improved significantly (P<0.001), 6MWD increased from (307.08±129.51) m to (428.00±112.64) m (P=0.002), the NT-proBNP decreased at 24 weeks post PTPA (P=0.002). During the follow-up period, there was no death; hemoptysis occurred in 4 patients during the operation, none of which resulted in serious adverse clinical consequences. One patient developed reperfusion pulmonary edema and recovered after treatment. Conclusion: PTPA treatment is safe and can significantly improve the hemodynamics and WHO functional class of patients with CTEPH.

Effects of stellate ganglionic block on hemodynamic changes and intrapulmonary shunt in perioperative patients with esophageal cancer.

OBJECTIVE: The aim of this study was to observe the effects of stellate ganglion block (SGB) on hemodynamic changes and intrapulmonary shunt during one-lung ventilation (OLV). PATIENTS AND METHODS: Thirty ASA class I-II patients undergoing elective esophageal surgery were randomly divided into two groups: general anesthesia group (group N, n=15) and general anesthesia combined SGB group (group S, n=15), patients in group S were received left SGB before induction. Radial artery was cannulated for arterial blood pressure (ABP) monitoring and blood sampling and Swan-Ganz catheter was position in the pulmonary artery via right internal jugular vein under local anesthesia. ECG, MAP, HR, CVP, continuous cardiac output (CCO) index and BIS were continuously monitored during anesthesia. General anesthesia was induced with propofol 1.5-2.0 mg/kg, sufentanil 0.4 µg/kg, and Rocuronium 0.6-0.9 mg/kg. Endobronchial occluder was placed blindly after tracheal indubation and the correct position was verified by auscultation and fiberoptic bronchoscopy. The patients were mechanically ventilated. The ventilation conditions were Fio2=100%, VT = 8-10 ml/kg, I: E = 1:2 and respiratory rate was adjusted to maintained PETCO2 at 35-45 mmHg during both two-lung ventilation (TLV) and OLV. Anesthesia was maintained with continuous infusion of propofol 4-10 mg/kg·h, sufentanil 0.2 µg/kg·h, vecuronium o.1 mg/kg·h, BIS was maintained at 45-55. Blood samples were taken from radial artery and S-G catheter for blood gas analysis at following intervals: during spontaneous breathing when the patient was awake (T0), 1 min after tracheal indubation (T1), 1 min after patient was placed in lateral position (T2) and 15 min after it (T3), 1 min after ribs was braced (T4), 30, 60, 120 min during the course of OLV (T5, T6, T7), the two lungs were ventilated again for 30 min (T8) and Qs/Qt was calculated. RESULTS: SVRI, MAP, HR in group N increased significantly at T1, T2, T4 compared with group S (p < 0.05). Qs/Qt was significantly increased after patient was placed in lateral position and increased further during OLV; the calculated Qs/Qt values were highest at T5· PaO2 was significantly lower after OLV was started and reached the lowest level at T6 then was gradually increasing. There was no significant difference in Qs/Qt and PaO2 at all time points between two groups. CONCLUSIONS: SGB before induction effectively suppress the stress response work as stable blood dynamics and does not affect Qs/Qt and arterial oxygenation during OLV, SGB is a safe technique of anesthesia for general thoracic surgery.

The impact of intensified supervisory activities on tuberculosis treatment.

A Health Subcentre-based randomized controlled trial was conducted in order to determine the importance of the motivation of the tuberculosis personnel in improving the results of a treatment programme. A total of 1300 newly detected tuberculosis patients from 7 Health Centres were divided into study and control groups using the Health Subcentre areas as sampling units. In the study group, worker motivation was intensified through special regular sessions and closer supervision, while in the control group the usual procedures were followed. Treatment performance was remarkably improved in the study areas: treatment completion rate was 78.8% in the study group, compared with 65.2% in the control group. Bacteriological conversions among those having completed the treatment were 91.9% and 62.2% respectively, and overall efficacy was 75.2% and 45.8%, respectively. In addition to improved treatment, the follow-up case examinations also showed markedly increased performance. Although this study was done in facilities using conventional regimens which have been replaced with short-course regimens more recently, the study results still clearly indicate the importance of motivating personnel in the field to attain better case management.

Analysis of case-finding process of tuberculosis in Korea.

A total of 630 pulmonary tuberculosis patients newly registered with the health centres in the Republic of Korea were interviewed to determine their process of case-finding. One-quarter of the cases had a previous history of tuberculosis. About 70% of these retreatment cases had been treated for less than 1 year, indicating the importance of more thorough follow-through during treatment. Almost all of the cases had at least one standard symptom, with fatigue being most frequent, followed by cough and sputum. On developing the illness, about 40% of the cases were motivated to seek medical help after seeking advice from people other than family members such as friends or health workers. Half of the patients first went to the health centre, and one-third to a private clinic. The average time between the onset of symptoms and the initial medical consultation was 1.8 months (patient's delay). This delay is longer in the rural areas; besides location no other patient characteristics had any correlation with patient's delay. Nearly 80% of all cases were diagnosed as tuberculous within the first 2 weeks. Health centres diagnosed cases faster than private clinics and thus had a shorter doctor's delay. Mean total delay (patient's delay plus doctor's delay) was 2 months, with 80% of this being patient's delay.

Bile secretory immunoglobulin A in biliary infection and cholelithiasis.

Bile samples from 71 patients with cholelithiasis and a control group of 10 subjects without hepatobiliary diseases were cultured for bacteria and measured for secretory immunoglobulin A (SIgA) using enzyme immunoassay specific for SIgA. The results of bile bacterial culture were all positive in patients with primary bile duct pigment stones, and significantly lower bile SIgA levels were observed than in normal controls (P less than 0.005). It was also shown that the constitutent ratios of SIgA to total bile immunoglobulin and the bile-serum ratio of SIgA were markedly lower in these patients than in normal controls (P less than 0.001, P less than 0.001). In patients with cholecystolithiasis, bile SIgA concentrations of patients with biliary infections were remarkably lower than those of patients without biliary infection (P less than 0.01) and those of normal controls (P less than 0.01). These results suggest a close relationship between biliary tract infection and low concentrations of bile SIgA.

A contact study to evaluate the BCG vaccination programme in Seoul.

A contact study was undertaken in Seoul to determine the protective effect of the BCG programme in children up to 5 years of age. There were 1993 contact children to 4484 smear-positive patients with pulmonary tuberculosis. 1223 completed the examination, 806 had evidence of BCG vaccination, 417 had not. In total, 129 or 126 children were considered cases of tuberculosis according to radiological/clinical classification or scoring system, respectively. For the unvaccinated the respective numbers of cases were 84 and 80 and for the vaccinated 45 and 46. The data were stratified for factors that could have distorted comparability: age and sex, relationship of index case, feeding habits, room occupancy, treatment history of index case and health centre that diagnosed the index case. Only age was found to have a small effect. Correcting for this, the observed level of protection was 74% with 95% confidence limits of 62% and 82%. It appeared to be the same for all types of disease observed.

Comparison of a daily and three intermittent retreatment regimens for pulmonary tuberculosis administered under programme conditions.

One daily and 3 thrice weekly retreatment regimens given for 12 months under programme conditions were compared. The daily regimen was rifampicin and ethambutol (RE7). The three intermittent regimens also contained rifampicin and ethambutol: one of them, rifampicin and ethambutol throughout (RE3); the next one supplemented with pyrazinamide for the first 3 months (REZ3); the last one supplemented with prothionamide for the first 3 months (REPt3). The pyrazinamide containing regimen was subdivided into ordinary and high dose groups. The subjects for retreatment were those who have had, at least, more than 6 months of initial triple chemotherapy of isoniazid, PAS and streptomycin at the health centres, and failed to convert to bacteriologically negative status. Among 419 patients who were available for sensitivity tests before commencing retreatment, 393 (94.3%) were resistant to isoniazid. Six hundred and seventy-four patients (674) were allocated randomly to the regimens: 64 patients were excluded due to various pretreatment reasons and 109 did not complete 12 months of chemotherapy. There remain 501 patients who completed their retreatment. As assessed at 12 months, a bacteriologically favourable response was achieved in 68% of 135 RE7 patients, 62% of 129 RE3 patients, 74% of 132 REZ3 patients, and in 79% of 108 REPt3 patients. Adverse reactions were uncommon: 4% in RE7, 5% in RE3 and 9% in REZ3, but 32% in REPt3. Relapse rates during 2 years after termination of chemotherapy were 15% in RE7, 14% in RE3 and REZ3, and 26% in REPt3, as calculated by life table analysis.

Activities of cefoxitin and cefotetan against Mycobacterium fortuitum infections in mice.

Mice inoculated intravenously with Mycobacterium fortuitum 18367 were treated subcutaneously with cefoxitin or cefotetan once daily for 4 weeks, beginning 24 h after challenge. Both drugs suppressed spinning disease, and both reduced the severity of renal lesions and the number of organisms in the kidneys and liver but not in the lungs or spleen. These therapeutic effects were dose-dependent.

Environmental mycobacteria in Korea. I. Distribution of the organisms.

Environmental mycobacteria in Korea have been investigated by examining 54 soil, 111 house dust, 63 well water, and 98 sewage samples collected from 123 randomly selected areas in Korea during the fourth nationwide tuberculosis prevalence survey in 1980. A variety of mycobacteria were isolated from 76% of soil, 67% of sewage, 43% of well water, and 7% of house dust samples. Some samples yielded more than one species; thus 56 strains were obtained from soil, 107 strains from sewage, 48 strains from well water and 8 strains from house dust. Mycobacterium fortuitum was the most common species of environmental mycobacteria in Korea and the species was distributed equally in all types of samples tested. The M. terrae complex was also one of the common species of environmental mycobacteria and it seemed to be more abundant in water samples than in soil. Scotochromogenic slow growers M. scrofulaceum and M. gordonae were common microbes in soil and water samples, although the latter was more frequently detected in water samples. Scotochromogenic rapid growers M. flavescens and M.phlei, and photochromogenic rapid grower M. vaccae were isolated more frequently from sewage or water samples than from soil. Nonphotochromogenic rapid growers M. chelonei (chelonae) and M. smegmatis were isolated mostly from sewage and the former was rarely found in soil and well water samples. The clinically important species M. avium-intracellulare complex was found less frequently in all types of test samples.