News about Medicine - Part 6

The Tuberculosis Clinic: Results

From 1978 to 1987, 290 episodes of tuberculosis in 260 patients were identified. Excluded from the study were six who had not completed therapy by the beginning of 1987, 34 whose treatment started before 1978, 65 who either died in the hospital or were referred to another treatment source after discharge from the hospital, and one whose medical record was not available. Of the 184 episodes in 168 remaining patients, 104 were followed up in the general clinics and 80 were followed up in the tuberculosis clinic. Except for two patients, those followed up in the general clinics developed disease from 1977 to 1982 and those in the tuberculosis clinic developed disease from 1982 to 1986. Men outnumbered women 182 to 2. Twenty-one of the general clinic group and 45 of the tuberculosis clinic group were documented alcohol abusers. There were nine patients in the general clinics group (10 percent) and seven in the tuberculosis clinic group (9 percent) who were treated for tuberculosis a second time. The results, after excluding the repeat episodes, were similar to those obtained from analyzing all episodes so the numbers reported are the total episodes of tuberculosis treated. Read the rest of this entry »

The Tuberculosis Clinic: Methods

The Tuberculosis Clinic: MethodsMethods
The medical records from 1978 to 1987 for all patients with a documented diagnosis of pulmonary tuberculosis were reviewed. The diagnosis was made by either a report from the laboratory of Mycobacterium tuberculosis growing in culture or a physicians note of a positive sputum smear or culture. The following were compiled from the medical record: the year of diagnosis, the presence of alcohol abuse, the completion of treatment, the drugs given and whether the regimen followed American Thoracic Society guidelines, the follow-up, whether the patient was alive at the end of treatment, and whether the patient was referred to a treatment source outside of the medical center. Read the rest of this entry »

The Tuberculosis Clinic: Outpatients

The patients were evaluated initially by a pulmonary fellow and the clinic attending pulmonary physician and thereafter monthly by the same nurse specialist. The pulmonologist saw all patients to start, stop or change therapy, to review radiographs and abnormal clinical data and to evaluate other medical problems. Documentation was standardized by use of printed progress notes. Patients who missed their appointments were called that day and rescheduled for the following clinic day. All patients who refused treatment or who defaulted were promptly referred to the Board of Health for follow-up. Read the rest of this entry »

The Tuberculosis Clinic

The Tuberculosis ClinicTreatment of tuberculosis is more than 95 percent effective for patients who complete a course of medication as recommended by the American Thoracic Society. However, success often is not attained because of patient noncompliance which is the greatest obstacle to the successful treatment and elimination of tuberculosis. At our medical center, treatment of patients with tuberculosis has been carried out in the general outpatient clinics, often in the clinic where patients were followed up for other medical problems. In this setting, the clinic physician chose the type and duration of antituberculosis medication, the frequency of return appointments, and length of follow-up. Several problems with this treatment method recurred. Patients were not seen by the same physician at each clinic visit. Patient records were not always available. A mechanism did not exist for contacting patients who missed appointments. Patients who defaulted from treatment were not identified or referred to the Board of Health. Here
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Association of Activated Cytolytic Lung Lymphocytes with Response to Prednisone Therapy: Discussion

Numerous studies of cell-mediated immune phenomena in interstitial lung diseases have been reported. The role of activated cytolytic lymphocytes has not been previously investigated, despite the importance of these as major effector components of the immune response. Ours is the first report, to our knowledge, demonstrating the presence of activated cytolytic cells in the BAL fluid of some patients with IPF. Longitudinal studies indicated that this subgroup of IPF patients responded to prednisone therapy with improved pulmonary function, and, significantly, clinical improvement was associated with decreased lectin-dependent cytolytic lymphocyte activity in BAL fluid. Patients with cytolytic activity in peripheral blood but not in BAL fluid and patients without cytolytic activity from either source did not respond to prednisone therapy. Patients with IPF who had lectin-dependent activity in BAL fluid may constitute a subgroup who have more active inflammation or are in an earlier stage of disease then IPF patients without initial cytolytic activity. Read the rest of this entry »

Association of Activated Cytolytic Lung Lymphocytes with Response to Prednisone Therapy: Initial Cell Counts

Association of Activated Cytolytic Lung Lymphocytes with Response to Prednisone Therapy: Initial Cell CountsInitial Cell Counts
The median total and median differential initial cell counts of IPF patients and of normal subjects are shown in Table 1. These data demonstrate increased total cell numbers and percentages of polymorphonuclear lymphocytes in BAL fluid of patients with IPF. Some patients with IPF also had increased percentages of lymphocytes. The above findings are consistent with previous reports of IPF alveolitis. Read the rest of this entry »

Association of Activated Cytolytic Lung Lymphocytes with Response to Prednisone Therapy: Results

Concanavalin A-Dependent Cell-mediated Cytotoxicity Assay: The CDCMC assay was used to measure activated lymphocyte killing, as published elsewhere. In brief, the murine mastocytoma cell line P815 (1-2×10 cells/ml) was suspended in 0.3 ml of medium; 0.3 ml of Tris phosphate buffer, ph 7.4; and 100 to 200 μCi of sodium 5ICr chromate (Amersham Corp). The P815 target cells were then incubated for 30 min at 37°C, washed three times and resuspended in medium at 1.25 x 104 viable cells/ml. Con A, 80 n-g/ml, was added to the target cells to give a 2 x concentration relative to the final concentration in the assay. One hundred microliters of 5lCr-labeled P815 cells was then dispensed into triplicate wells of a 96 well V-bottom microtiter plate (Nunc). Read the rest of this entry »

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