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Robert L. Hunter - One of the best experts on this subject based on the ideXlab platform.
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doi:10.1155/2011/307631 Research Article Immunopathology of Postprimary Tuberculosis: Increased T-Regulatory Cells and DEC-205-Positive Foamy Macrophages in
2013Co-Authors: Cavitary Lesions, Kerry J. Welsh, Jeffrey K. Actor, Semyon A. Risin, Robert L. HunterAbstract:which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Postprimary Tuberculosis occurs in immunocompetent people infected with Mycobacterium Tuberculosis. It is restricted to the lung and accounts for 80 % of cases and nearly 100 % of transmission. Little is known about the immunopathology of Postprimary Tuberculosis due to limited availability of specimens. Tissues from 30 autopsy cases of pulmonary Tuberculosis were located. Sections of characteristic lesions of caseating granulomas, lipid pneumonia, and cavitary stages of Postprimary disease were selected for immunohistochemical studies of macrophages, lymphocytes, endothelial cells, and mycobacterial antigens. A higher percentage of cells in lipid pneumonia (36.1%) and cavitary lesions (27.8%) were positive for the dendritic cell marker DEC-205, compared to granulomas (9.0%, P<.05). Cavities contained significantly more T-regulatory cells (14.8%) than found in lipid pneumonia (5.2%) or granulomas (4.8%). Distribution of the immune cell types may contribute to the inability of the immune system to eradicate Tuberculosis. 1
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Immunopathology of Postprimary Tuberculosis: Increased T-Regulatory Cells and DEC-205-Positive Foamy Macrophages in Cavitary Lesions
Hindawi Limited, 2011Co-Authors: Kerry J. Welsh, Jeffrey K. Actor, Semyon A. Risin, Robert L. HunterAbstract:Postprimary Tuberculosis occurs in immunocompetent people infected with Mycobacterium Tuberculosis. It is restricted to the lung and accounts for 80% of cases and nearly 100% of transmission. Little is known about the immunopathology of Postprimary Tuberculosis due to limited availability of specimens. Tissues from 30 autopsy cases of pulmonary Tuberculosis were located. Sections of characteristic lesions of caseating granulomas, lipid pneumonia, and cavitary stages of Postprimary disease were selected for immunohistochemical studies of macrophages, lymphocytes, endothelial cells, and mycobacterial antigens. A higher percentage of cells in lipid pneumonia (36.1%) and cavitary lesions (27.8%) were positive for the dendritic cell marker DEC-205, compared to granulomas (9.0%, P
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Immunopathology of Postprimary Tuberculosis: Increased T-regulatory cells and DEC-205-positive foamy macrophages in cavitary lesions
Clinical & developmental immunology, 2010Co-Authors: Kerry J. Welsh, Jeffrey K. Actor, Semyon A. Risin, Robert L. HunterAbstract:Postprimary Tuberculosis occurs in immunocompetent people infected with Mycobacterium Tuberculosis. It is restricted to the lung and accounts for 80% of cases and nearly 100% of transmission. Little is known about the immunopathology of Postprimary Tuberculosis due to limited availability of specimens. Tissues from 30 autopsy cases of pulmonary Tuberculosis were located. Sections of characteristic lesions of caseating granulomas, lipid pneumonia, and cavitary stages of Postprimary disease were selected for immunohistochemical studies of macrophages, lymphocytes, endothelial cells, and mycobacterial antigens. A higher percentage of cells in lipid pneumonia (36.1%) and cavitary lesions (27.8%) were positive for the dendritic cell marker DEC-205, compared to granulomas (9.0%, P < .05). Cavities contained significantly more T-regulatory cells (14.8%) than found in lipid pneumonia (5.2%) or granulomas (4.8%). Distribution of the immune cell types may contribute to the inability of the immune system to eradicate Tuberculosis.
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TB research at UT-Houston--a review of cord factor: new approaches to drugs, vaccines and the pathogenesis of Tuberculosis.
Tuberculosis, 2009Co-Authors: Robert L. Hunter, Chinnaswamy Jagannath, Lisa Y. Armitige, Jeffrey K. ActorAbstract:Tuberculosis remains a major threat as drug resistance continues to increase. Pulmonary Tuberculosis in adults is responsible for 80% of clinical cases and nearly 100% of transmission of infection. Unfortunately, since we have no animal models of adult type pulmonary Tuberculosis, the most important type of disease remains largely out of reach of modern science and many fundamental questions remain unanswered. This paper reviews research dating back to the 1950's providing compelling evidence that cord factor (trehalose 6,6 dimycolate [TDM]) is essential for understanding Tuberculosis. However, the original papers by Bloch and Noll were too far ahead of their time to have immediate impact. We can now recognize that the physical and biologic properties of cord factor are unprecedented in science, especially its ability to switch between two sets of biologic activities with changes in conformation. While TDM remains on organisms, it protects them from killing within macrophages, reduces antibiotic effectiveness and inhibits the stimulation of protective immune responses. If it comes off organisms and associates with lipid, TDM becomes a driver of tissue damage and necrosis. Studies emanating from cord factor research have produced (1) a rationale for improving vaccines, (2) an approach to new drugs that overcome natural resistance to antibiotics, (3) models of caseating granulomas that reproduce multiple manifestations of human Tuberculosis. (4) evidence that TDM is a key T cell antigen in destructive lesions of Tuberculosis, and (5) a new understanding of the pathology and pathogenesis of Postprimary Tuberculosis that can guide more informative studies of long standing mysteries of Tuberculosis.
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Pathology of Postprimary Tuberculosis in humans and mice: contradiction of long-held beliefs.
Tuberculosis (Edinburgh Scotland), 2007Co-Authors: Robert L. Hunter, Chinnaswamy Jagannath, Jeffrey K. ActorAbstract:Tuberculosis remains one of the world's leading infectious causes of death. Approximately 80% of all disease is due to Postprimary (secondary) Tuberculosis in the lung. Unfortunately, tissues of developing lesions are seldom available and there are no recognized models of Postprimary Tuberculosis. In the preantibiotic era when tissues were more abundant, several investigators described early Postprimary Tuberculosis as a lipid pneumonia quite different from the caseating granulomas commonly described today. We used histopathologic, immunohistochemical and acid fast stains to examine tissues from several people with untreated primary and Postprimary Tuberculosis and compared the findings with those of mice with reactivation Tuberculosis. The results confirmed that developing Postprimary Tuberculosis begins as a lipid pneumonia accompanied by bronchial obstruction in which infection is restricted to foamy alveolar macrophages. Cavities result from a combination of caseation of tuberculous pneumonia and microvascular occlusion characteristic of delayed type hypersensitivity (DTH). Reactivation Tuberculosis in the mouse begins as a similar tuberculous lipid pneumonia with bronchial obstruction and evidence for participation of DTH. Developing necrosis in both species is associated with localization of organisms within lipid droplets. These results suggest that reactivation Tuberculosis in mice is a valuable model of developing human Postprimary Tuberculosis.
Giuseppe Vertemati - One of the best experts on this subject based on the ideXlab platform.
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Modern Morbidity following Pulmonary Resection for Postprimary Tuberculosis
World Journal of Surgery, 1997Co-Authors: Adriano Rizzi, Gaetano Rocco, Mario Robustellini, G. Rossi, Claudio Della Pona, Giuseppe VertematiAbstract:n = 8), multidrug resistance or noncompliance to the medical treatment ( n = 11), parenchymal sequelae ( n = 3), suspected cancer ( n = 5), and for the correction of postpneumonectomy bronchopleural fistula and empyema ( n = 1). On admission, eight patients presented with sputum positivity (28.6%). Similar to previous series, tubercular predilection for upper lobes was confirmed (21/28, 75%); accordingly, upper lobectomy through an extrapleural approach was the most common procedure (16/28, 57.1%). Atypical segmental resections or segmentectomies were performed in seven patients (25%), whereas a bilobectomy was necessary in another three patients (10.7%) and a completion pneumonectomy in one (3.6%). Additional procedures were an open-window thoracostomy with transpericardial closure of the main bronchus and a tailored thoracoplasty. No operative mortality was reported. Healing was achieved in 26 patients (93%). Bleeding, either from the chest wall or hilar dissection, was the only reported intraoperative complication. Median blood loss, inclusive of early postoperative collections from chest tubes, reached 1330 ml (range 100–3700 ml). Major postoperative complications included recurrent disease (2/28, 7%) in sputum-positive patients and segmental pulmonary embolism (3.5%). Causes of minor morbidity were air leaks resulting in residual space undergoing spontaneous resolution (18%), wound breakdown (14%), and, fever (11%). This limited series confirms the therapeutic value of the surgical treatment of Postprimary Tuberculosis, provided that correct indications, adequate pre- and postoperative medical coverage, and meticulous technique are applied.
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Modern morbidity following pulmonary resection for Postprimary Tuberculosis.
World journal of surgery, 1997Co-Authors: Adriano Rizzi, Gaetano Rocco, Mario Robustellini, G. Rossi, Claudio Della Pona, Giuseppe VertematiAbstract:Between January 1991 and March 1996, a total of 28 patients with Postprimary Tuberculosis underwent resection for disease progression (n = 8), multidrug resistance or noncompliance to the medical treatment (n = 11), parenchymal sequelae (n = 3), suspected cancer (n = 5), and for the correction of postpneumonectomy bronchopleural fistula and empyema (n = 1). On admission, eight patients presented with sputum positivity (28.6%). Similar to previous series, tubercular predilection for upper lobes was confirmed (21/28, 75%); accordingly, upper lobectomy through an extrapleural approach was the most common procedure (16/28, 57.1%). Atypical segmental resections or segmentectomies were performed in seven patients (25%), whereas a bilobectomy was necessary in another three patients (10.7%) and a completion pneumonectomy in one (3.6%). Additional procedures were an open-window thoracostomy with transpericardial closure of the main bronchus and a tailored thoracoplasty. No operative mortality was reported. Healing was achieved in 26 patients (93%). Bleeding, either from the chest wall or hilar dissection, was the only reported intraoperative complication. Median blood loss, inclusive of early postoperative collections from chest tubes, reached 1330 ml (range 100-3700 ml). Major postoperative complications included recurrent disease (2/28, 7%) in sputum-positive patients and segmental pulmonary embolism (3.5%). Causes of minor morbidity were air leaks resulting in residual space undergoing spontaneous resolution (18%), wound breakdown (14%), and, fever (11%). This limited series confirms the therapeutic value of the surgical treatment of Postprimary Tuberculosis, provided that correct indications, adequate pre- and post-operative medical coverage, and meticulous technique are applied.
Jeffrey K. Actor - One of the best experts on this subject based on the ideXlab platform.
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doi:10.1155/2011/307631 Research Article Immunopathology of Postprimary Tuberculosis: Increased T-Regulatory Cells and DEC-205-Positive Foamy Macrophages in
2013Co-Authors: Cavitary Lesions, Kerry J. Welsh, Jeffrey K. Actor, Semyon A. Risin, Robert L. HunterAbstract:which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Postprimary Tuberculosis occurs in immunocompetent people infected with Mycobacterium Tuberculosis. It is restricted to the lung and accounts for 80 % of cases and nearly 100 % of transmission. Little is known about the immunopathology of Postprimary Tuberculosis due to limited availability of specimens. Tissues from 30 autopsy cases of pulmonary Tuberculosis were located. Sections of characteristic lesions of caseating granulomas, lipid pneumonia, and cavitary stages of Postprimary disease were selected for immunohistochemical studies of macrophages, lymphocytes, endothelial cells, and mycobacterial antigens. A higher percentage of cells in lipid pneumonia (36.1%) and cavitary lesions (27.8%) were positive for the dendritic cell marker DEC-205, compared to granulomas (9.0%, P<.05). Cavities contained significantly more T-regulatory cells (14.8%) than found in lipid pneumonia (5.2%) or granulomas (4.8%). Distribution of the immune cell types may contribute to the inability of the immune system to eradicate Tuberculosis. 1
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Immunopathology of Postprimary Tuberculosis: Increased T-Regulatory Cells and DEC-205-Positive Foamy Macrophages in Cavitary Lesions
Hindawi Limited, 2011Co-Authors: Kerry J. Welsh, Jeffrey K. Actor, Semyon A. Risin, Robert L. HunterAbstract:Postprimary Tuberculosis occurs in immunocompetent people infected with Mycobacterium Tuberculosis. It is restricted to the lung and accounts for 80% of cases and nearly 100% of transmission. Little is known about the immunopathology of Postprimary Tuberculosis due to limited availability of specimens. Tissues from 30 autopsy cases of pulmonary Tuberculosis were located. Sections of characteristic lesions of caseating granulomas, lipid pneumonia, and cavitary stages of Postprimary disease were selected for immunohistochemical studies of macrophages, lymphocytes, endothelial cells, and mycobacterial antigens. A higher percentage of cells in lipid pneumonia (36.1%) and cavitary lesions (27.8%) were positive for the dendritic cell marker DEC-205, compared to granulomas (9.0%, P
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Immunopathology of Postprimary Tuberculosis: Increased T-regulatory cells and DEC-205-positive foamy macrophages in cavitary lesions
Clinical & developmental immunology, 2010Co-Authors: Kerry J. Welsh, Jeffrey K. Actor, Semyon A. Risin, Robert L. HunterAbstract:Postprimary Tuberculosis occurs in immunocompetent people infected with Mycobacterium Tuberculosis. It is restricted to the lung and accounts for 80% of cases and nearly 100% of transmission. Little is known about the immunopathology of Postprimary Tuberculosis due to limited availability of specimens. Tissues from 30 autopsy cases of pulmonary Tuberculosis were located. Sections of characteristic lesions of caseating granulomas, lipid pneumonia, and cavitary stages of Postprimary disease were selected for immunohistochemical studies of macrophages, lymphocytes, endothelial cells, and mycobacterial antigens. A higher percentage of cells in lipid pneumonia (36.1%) and cavitary lesions (27.8%) were positive for the dendritic cell marker DEC-205, compared to granulomas (9.0%, P < .05). Cavities contained significantly more T-regulatory cells (14.8%) than found in lipid pneumonia (5.2%) or granulomas (4.8%). Distribution of the immune cell types may contribute to the inability of the immune system to eradicate Tuberculosis.
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TB research at UT-Houston--a review of cord factor: new approaches to drugs, vaccines and the pathogenesis of Tuberculosis.
Tuberculosis, 2009Co-Authors: Robert L. Hunter, Chinnaswamy Jagannath, Lisa Y. Armitige, Jeffrey K. ActorAbstract:Tuberculosis remains a major threat as drug resistance continues to increase. Pulmonary Tuberculosis in adults is responsible for 80% of clinical cases and nearly 100% of transmission of infection. Unfortunately, since we have no animal models of adult type pulmonary Tuberculosis, the most important type of disease remains largely out of reach of modern science and many fundamental questions remain unanswered. This paper reviews research dating back to the 1950's providing compelling evidence that cord factor (trehalose 6,6 dimycolate [TDM]) is essential for understanding Tuberculosis. However, the original papers by Bloch and Noll were too far ahead of their time to have immediate impact. We can now recognize that the physical and biologic properties of cord factor are unprecedented in science, especially its ability to switch between two sets of biologic activities with changes in conformation. While TDM remains on organisms, it protects them from killing within macrophages, reduces antibiotic effectiveness and inhibits the stimulation of protective immune responses. If it comes off organisms and associates with lipid, TDM becomes a driver of tissue damage and necrosis. Studies emanating from cord factor research have produced (1) a rationale for improving vaccines, (2) an approach to new drugs that overcome natural resistance to antibiotics, (3) models of caseating granulomas that reproduce multiple manifestations of human Tuberculosis. (4) evidence that TDM is a key T cell antigen in destructive lesions of Tuberculosis, and (5) a new understanding of the pathology and pathogenesis of Postprimary Tuberculosis that can guide more informative studies of long standing mysteries of Tuberculosis.
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Pathology of Postprimary Tuberculosis in humans and mice: contradiction of long-held beliefs.
Tuberculosis (Edinburgh Scotland), 2007Co-Authors: Robert L. Hunter, Chinnaswamy Jagannath, Jeffrey K. ActorAbstract:Tuberculosis remains one of the world's leading infectious causes of death. Approximately 80% of all disease is due to Postprimary (secondary) Tuberculosis in the lung. Unfortunately, tissues of developing lesions are seldom available and there are no recognized models of Postprimary Tuberculosis. In the preantibiotic era when tissues were more abundant, several investigators described early Postprimary Tuberculosis as a lipid pneumonia quite different from the caseating granulomas commonly described today. We used histopathologic, immunohistochemical and acid fast stains to examine tissues from several people with untreated primary and Postprimary Tuberculosis and compared the findings with those of mice with reactivation Tuberculosis. The results confirmed that developing Postprimary Tuberculosis begins as a lipid pneumonia accompanied by bronchial obstruction in which infection is restricted to foamy alveolar macrophages. Cavities result from a combination of caseation of tuberculous pneumonia and microvascular occlusion characteristic of delayed type hypersensitivity (DTH). Reactivation Tuberculosis in the mouse begins as a similar tuberculous lipid pneumonia with bronchial obstruction and evidence for participation of DTH. Developing necrosis in both species is associated with localization of organisms within lipid droplets. These results suggest that reactivation Tuberculosis in mice is a valuable model of developing human Postprimary Tuberculosis.
Stefan H. E. Kaufmann - One of the best experts on this subject based on the ideXlab platform.
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Differential Organization of the Local Immune Response in Patients with Active Cavitary
2016Co-Authors: Tuberculosis Or Nonprogressive Tuberculoma, Nadya Gushina, Stefan H. E. KaufmannAbstract:Background. In 90 % of all cases, Mycobacterium Tuberculosis infection results in latency rather than active disease, with the pathogen being contained within granulomatous lesions at the site of primary infection. Failure of this containment leads to reactivation of Postprimary Tuberculosis (TB). The regional immune processes that sustain the delicate balance with persistent M. Tuberculosis, however, remain unclear. Methods. We compared activation statuses, biological functions, and interactions of host immune cells in human nonprogressive tuberculoma and active cavitary tuberculous lung tissue. Results. Dissection of early granuloma formations revealed differential cellular distribution and activation statuses of distinct cell types in different regions relative to the central caseotic caverna or the tuberculoma in tuberculous lung tissue. In patients with tuberculoma with latent infection, distant parts of lung tissue exhibited strong vascularization and profound proliferative activity, indicating that continuous immune defense is required for mycobacterial containment, which is absent in cavitary tuberculous lung lesions. Conclusions. We conclude that differential regulation of the local immune response is crucial for the con-tainment of M. Tuberculosis and that a continuous antigen-specific cross talk between the host immune system and M. Tuberculosis is ensured during latency. This activation requires sufficient supply of nutrients and well-coordinated structural organization, both of which are lost during reactivation of TB
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Differential Organization of the Local Immune Response in Patients with Active Cavitary Tuberculosis or with Nonprogressive Tuberculoma
The Journal of infectious diseases, 2005Co-Authors: Timo Ulrichs, George A. Kosmiadi, Sabine Jörg, Lydia Pradl, Marina Titukhina, Vladimir Mishenko, Nadya Gushina, Stefan H. E. KaufmannAbstract:Background. In 90% of all cases, Mycobacterium Tuberculosis infection results in latency rather than active disease, with the pathogen being contained within granulomatous lesions at the site of primary infection. Failure of this containment leads to reactivation of Postprimary Tuberculosis (TB). The regional immune processes that sustain the delicate balance with persistent M. Tuberculosis, however, remain unclear. Methods. We compared activation statuses, biological functions, and interactions of host immune cells in human nonprogressive tuberculoma and active cavitary tuberculous lung tissue. Results. Dissection of early granuloma formations revealed differential cellular distribution and activation statuses of distinct cell types in different regions relative to the central caseotic caverna or the tuberculoma in tuberculous lung tissue. In patients with tuberculoma with latent infection, distant parts of lung tissue exhibited strong vascularization and profound proliferative activity, indicating that continuous immune defense is required for mycobacterial containment, which is absent in cavitary tuberculous lung lesions. Conclusions. We conclude that differential regulation of the local immune response is crucial for the containment of M. Tuberculosis and that a continuous antigen-specific cross talk between the host immune system and M. Tuberculosis is ensured during latency. This activation requires sufficient supply of nutrients and well-coordinated structural organization, both of which are lost during reactivation of TB.
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Immune response to Postprimary Tuberculosis in mice: Mycobacterium Tuberculosis and Miycobacterium bovis bacille Calmette-Guerin induce equal protection
The Journal of infectious diseases, 2004Co-Authors: Hans-joachim Mollenkopf, Mischo Kursar, Stefan H. E. KaufmannAbstract:We addressed the question of whether protective immunity induced by natural infection with Mycobacterium Tuberculosis and that induced by vaccination with Mycobacterium bovis bacille Calmette-Guerin (BCG) differ in the murine model. We infected mice with M. Tuberculosis Erdman, cured them by chemotherapy, and subsequently reinfected them with a low dose of M. Tuberculosis H37Rv. The course of Tuberculosis was compared with that in mice previously vaccinated with BCG Danish 1331. Protection against Postprimary M. Tuberculosis infection did not differ significantly between the 2 groups. After challenge infection, numbers of interferon-γ-positive splenocytes did not differ between mice with primary infection and vaccinated mice. Splenocytes from primary M. Tuberculosis-infected mice conferred marginally higher protection than did those from BCG-vaccinated mice. Serum transfer did not protect against reinfection in either group. Our data emphasize that natural infection with M. Tuberculosis and vaccination with BCG do not differ in their capacity to induce protective immunity against Tuberculosis and support the notions that reinfection contributes to the development of active disease and that any novel vaccine against Tuberculosis has to perform better than both vaccination with BCG and immunity evoked by natural infection.
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Immune response to Postprimary Tuberculosis in mice: Mycobacterium Tuberculosis and Mycobacterium bovis bacille Calmette-Guerin induce equal protection
2004Co-Authors: Hans-joachim Mollenkopf, Mischo Kursar, Stefan H. E. KaufmannAbstract:We addressed the question of whether protective immunity induced by natural infection with Mycobacterium Tuberculosis and that induced by vaccination with Mycobacterium bovis bacille Calmette-Guérin (BCG) differ in the murine model. We infected mice with M. Tuberculosis Erdman, cured them by chemotherapy, and subsequently reinfected them with a low dose of M. Tuberculosis H37Rv. The course of Tuberculosis was compared with that in mice previously vaccinated with BCG Danish 1331. Protection against Postprimary M. Tuberculosis infection did not differ significantly between the 2 groups. After challenge infection, numbers of interferon-g–positive splenocytes did not differ between mice with primary infection and vaccinated mice. Splenocytes from primary M. Tuberculosis–infected mice conferred marginally higher protection than did those from BCG-vaccinated mice. Serum transfer did not protect against reinfection in either group. Our data emphasize that natural infection with M. Tuberculosis and vaccination with BCG do not differ in their capacity to induce protective immunity against Tuberculosis and support the notions that reinfection contributes to the development of active disease and that any novel vaccine against Tuberculosis has to perform better than both vaccination with BCG and immunity evoked by natural infection. Tuberculosis caused by the intracellular pathogen My-cobacterium Tuberculosis is one of the leading causes of morbidity and mortality worldwide [1]. Since the first isolation of the tubercle bacillus by Robert Koch in 1882, different animal models have been applied [2, 3]. Although the guinea pig model has the advantage of a pathological process similar to that in human pulmo-nary Tuberculosis, the mouse provides the best immu-nologically characterized model [4, 5]
Adriano Rizzi - One of the best experts on this subject based on the ideXlab platform.
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Modern Morbidity following Pulmonary Resection for Postprimary Tuberculosis
World Journal of Surgery, 1997Co-Authors: Adriano Rizzi, Gaetano Rocco, Mario Robustellini, G. Rossi, Claudio Della Pona, Giuseppe VertematiAbstract:n = 8), multidrug resistance or noncompliance to the medical treatment ( n = 11), parenchymal sequelae ( n = 3), suspected cancer ( n = 5), and for the correction of postpneumonectomy bronchopleural fistula and empyema ( n = 1). On admission, eight patients presented with sputum positivity (28.6%). Similar to previous series, tubercular predilection for upper lobes was confirmed (21/28, 75%); accordingly, upper lobectomy through an extrapleural approach was the most common procedure (16/28, 57.1%). Atypical segmental resections or segmentectomies were performed in seven patients (25%), whereas a bilobectomy was necessary in another three patients (10.7%) and a completion pneumonectomy in one (3.6%). Additional procedures were an open-window thoracostomy with transpericardial closure of the main bronchus and a tailored thoracoplasty. No operative mortality was reported. Healing was achieved in 26 patients (93%). Bleeding, either from the chest wall or hilar dissection, was the only reported intraoperative complication. Median blood loss, inclusive of early postoperative collections from chest tubes, reached 1330 ml (range 100–3700 ml). Major postoperative complications included recurrent disease (2/28, 7%) in sputum-positive patients and segmental pulmonary embolism (3.5%). Causes of minor morbidity were air leaks resulting in residual space undergoing spontaneous resolution (18%), wound breakdown (14%), and, fever (11%). This limited series confirms the therapeutic value of the surgical treatment of Postprimary Tuberculosis, provided that correct indications, adequate pre- and postoperative medical coverage, and meticulous technique are applied.
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Modern morbidity following pulmonary resection for Postprimary Tuberculosis.
World journal of surgery, 1997Co-Authors: Adriano Rizzi, Gaetano Rocco, Mario Robustellini, G. Rossi, Claudio Della Pona, Giuseppe VertematiAbstract:Between January 1991 and March 1996, a total of 28 patients with Postprimary Tuberculosis underwent resection for disease progression (n = 8), multidrug resistance or noncompliance to the medical treatment (n = 11), parenchymal sequelae (n = 3), suspected cancer (n = 5), and for the correction of postpneumonectomy bronchopleural fistula and empyema (n = 1). On admission, eight patients presented with sputum positivity (28.6%). Similar to previous series, tubercular predilection for upper lobes was confirmed (21/28, 75%); accordingly, upper lobectomy through an extrapleural approach was the most common procedure (16/28, 57.1%). Atypical segmental resections or segmentectomies were performed in seven patients (25%), whereas a bilobectomy was necessary in another three patients (10.7%) and a completion pneumonectomy in one (3.6%). Additional procedures were an open-window thoracostomy with transpericardial closure of the main bronchus and a tailored thoracoplasty. No operative mortality was reported. Healing was achieved in 26 patients (93%). Bleeding, either from the chest wall or hilar dissection, was the only reported intraoperative complication. Median blood loss, inclusive of early postoperative collections from chest tubes, reached 1330 ml (range 100-3700 ml). Major postoperative complications included recurrent disease (2/28, 7%) in sputum-positive patients and segmental pulmonary embolism (3.5%). Causes of minor morbidity were air leaks resulting in residual space undergoing spontaneous resolution (18%), wound breakdown (14%), and, fever (11%). This limited series confirms the therapeutic value of the surgical treatment of Postprimary Tuberculosis, provided that correct indications, adequate pre- and post-operative medical coverage, and meticulous technique are applied.