Faculty Bibliography

Fiberoptic bronchoscopy is well established as a useful tool in the diagnosis of suspected cases of pulmonary tuberculosis that are sputum smear-negative. However, little attention has been focused on the role of transbronchial biopsy culture in the bacteriologic diagnosis of the disease. In this series of 12 patients with culture-proven pulmonary tuberculosis, we reviewed the results of transbronchial biopsy culture in comparison to the culture of prebronchoscopy sputa, postbronchoscopy sputa and bronchial washings. We found that transbronchial biopsy culture yielded positive cultures in only 16 percent (2/12) of these cases of proven tuberculosis and that transbronchial biopsy culture was not an exclusive source of culture-positive material in any of the patients studied. Although fiberoptic bronchoscopy may be quite helpful in establishing the diagnosis of tuberculosis in patients that are sputum smear-negative, our findings indicate that culture of transbronchial biopsy specimens contribute little to the bacteriologic diagnosis.

We reviewed the case histories and roentgenograms of 50 patients with spontaneous pneumothorax who underwent small lumen catheter aspiration. The results were analyzed with regard to the presence or absence of preexisting lung disease. Patients with no history of previous lung disease and no roentgenogram abnormality other than the pneumothorax had a 66 percent chance of successful reinflation using the technique of manual aspiration described here. Patients with evidence of tension pneumothorax, bullae, pleural adhesions, and active tuberculosis were treated unsuccessfully. None of the patients experienced any complication from this procedure. Our results indicate that many patients with spontaneous pneumothorax may be quickly and successfully treated with small lumen catheter manual aspiration.

Scurvy developed in a 56-year-old man with poor dietary intake and was associated with knee hemarthroses and synovial thickening. The synovial membrane showed interstitial hemorrhage and many large fibroblasts but little collagen and some disarray of vascular basement membrane. Hemarthroses and all knee symptoms completely resolved on a normal diet. To our knowledge, these are the first electron-microscopic studies of synovial membrane in human scurvy, and our findings support a defect in collagen synthesis as a factor in etiology.