PubMed Health⌕ Search

Biomedical subjects

L E Lema

Publications and source records attributed to L E Lema.

10 recordsLinked to original sources
PubMed1997

Comparison of PCR, culture, and histopathology for diagnosis of tuberculous pericarditis.

Nucleic acid amplification techniques for the diagnosis of tuberculosis (TB) are rapidly being developed. Scant work, however, has focused on pericardial TB. Using cryopreserved specimens from a prior study of pericarditis, we compared PCR to culture and histopathology for the diagnosis of tuberculous pericarditis in 36 specimens of pericardial fluid and 19 specimens of pericardial tissue from 20 patients. Fluid and tissue were cultured on Lowenstein-Jensen and Middlebrook solid media and in BACTEC radiometric broth. Tissue specimens were stained with hematoxylin-eosin, Ziehl-Neelsen, auramine O, and Kinyoun stains and were examined for granuloma formation and acid-fast bacilli. PCR was performed with both fluid and tissue with IS6110-based primers specific for the Mycobacterium tuberculosis complex by published methods. Sixteen of the 20 patients had tuberculous pericarditis and 4 patients had other diagnoses. TB was correctly diagnosed by culture in 15 (93%) patients, by PCR in 13 (81%) patients, and by histology in 13 of 15 (87%) patients. PCR gave one false-positive result for a patient with Staphylococcus aureus pericarditis. Considering the individual specimens as the unit of analysis, M. tuberculosis was identified by culture in 30 of 43 specimens (70%) from patients with tuberculous pericarditis and by PCR in 14 of 28 specimens (50%) from patients with tuberculous pericarditis (P > 0.15). The sensitivity of PCR was higher with tissue specimens (12 of 15; 80%) than with fluid specimens (2 of 13; 15%; P = 0.002). In conclusion, the overall accuracy of PCR approached the results of conventional methods, although PCR was much faster. Therefore, PCR merits further development in this regard. The sensitivity of PCR with pericardial fluid was poor, and false-positive results with PCR remain a concern.

Adolescent↗
PubMed1996

Appendicitis in Dar es Salaam, histological pattern.

Histology of 378 appendicectomy specimens submitted to the Histopathology Department of Muhimbili Medical Centre from its surgical wards over a 10 year period (1985 to 1994) were reviewed. There were 185 cases (48.9 pc) of acute appendicitis, 101 cases (26.7 pc) of chronic appendicitis, 74 (19.6 pc) normal appendices and 13 cases (3.5 pc) schistosomal appendicitis. There were two cases of tuberculous appendicitis and two cases of mucocele of the appendix. Apart from the high frequency of chronic appendicitis the histological findings in this study compare well with findings reported from other studies.

Acute Disease↗
PubMed1994

Tuberculous pericarditis in Tanzanian patients with and without HIV infection.

SETTING: Large academic medical center in Tanzania. OBJECTIVES: To determine the etiologies and outcomes of large pericardial effusions in HIV-infected and uninfected patients. DESIGN: Prospective cohort study of patients admitted with new large pericardial effusions, confirmed echocardiographically. Patients had pericardial biopsies and drainage with extensive analysis of tissue and fluid specimens, and were followed with clinical and echocardiographic examinations. RESULTS: Of 28 patients with large pericardial effusions, 19 were infected with HIV-1. 22 had invasive diagnostic procedures: 14 of 14 HIV-infected patients, but only 4 of 8 non-HIV-infected patients, had tuberculous pericarditis (P = 0.01). All but 1 of the HIV-infected patients had strongly positive tuberculin skin tests, and short-term outcomes were similar in the 2 groups. CONCLUSION: TB is the predominant cause of large pericardial effusion in HIV-infected patients in this setting; non-HIV-infected patients are more likely to have other etiologies. These patients were at an early stage of HIV infection and responded well to treatment. In settings where microbiological studies are not routinely available, HIV-infected patients with large pericardial effusions may be treated empirically for tuberculosis and monitored for improvement. If improvement does not follow within 2-4 weeks further studies are indicated. HIV-negative patients should undergo diagnostic evaluation initially.

Adolescent↗
PubMed1994

Operative management of achalasia of the oesophagus.

Twenty patients with achalasia of the oesophagus were managed in one thoracic surgical unit over a period of seven years. Eighteen of these were aged 16 to 40 years. There was a female:male ratio of 2:1. Dysphagia to both solids and liquids with diffuse bilateral parotid gland enlargement were the most common clinical features. All the patients had an oesophagomyotomy without an additional anti-reflux procedure. There was no mortality. The trans-thoracic approach for oesophagomyotomy was associated with better results without complications of gastro-oesophageal reflux. This approach is recommended and an additional routine anti-reflux procedure at the same sitting may be unnecessary.

Adolescent↗
PubMed1993

Surgical management of pyopericardium.

Forty three patients with pyopericardium were managed over a six year period. Pyomyositis and septic arthritis were the most common associated conditions and Staphylococcus aureus the commonest microorganism isolated. Mycobacterium tuberculosis was isolated in only three of the cases. Pericardiocentesis and various forms of pericardial windows were found to be associated with high rates of recurrences, inadequate drainage and subsequent constrictive pericarditis. Pericardiectomy should be done as an initial form of surgical treatment where the general condition of the patient permits, since this procedure is not associated with the adverse sequelae of aspiration and pericardial window procedures.

Adolescent↗
PubMed1991

Subxiphoid pericardiastomy in the management of pericardial effusions.

Subxiphoid pericardiostomy for diagnosis and treatment of pericardial effusion was used in 21 patients. Total evacuation of the pericardial contents, direct inspection to break down loculations, simultaneous biopsies of the pericardium and pericardial fluid samples for diagnostic tests were achieved while avoiding the need for repeated pericardiocentesis and more invasive and difficult open drainage methods. Complete drainage without recurrence was obtained in 19 patients with one death and recurrence of effusion in another one. Two of these 19 cases developed constrictive pericarditis on follow-up and required a pericardiectomy. No other complications were encountered. The procedure can be done safely under local anaesthesia for all types of pericardial effusions providing prompt and long term relief of the abnormal haemodynamics.

Adolescent↗
PubMed1991

Subxiphoid pericardiostomy in the management of pericardial effusions.

Subxiphoid pericardiostomy for diagnosis and treatment of pericardial effusion was used in 21 patients. Total evaluation of the pericardial contents, direct inspection to break down loculations, simultaneous biopsies of the pericardium and pericardial fluid samples for diagnostic tests were achieved while avoiding the need for repeated pericardiocentesis and more invasive and difficult open drainage methods. Complete drainage without recurrence was obtained in 19 patients with one death and recurrence of effusion in another one. Two of these 19 cases developed constrictive pericarditis on follow-up and required a pericardiectomy. No other complications were encountered. The procedure can be done safely under local anaesthesia for all types of pericardial effusions providing prompt and long term relief of the abnormal haemodynamics.

Adolescent↗
PubMed1989

Pulmonary alveolar microlithiasis: case report.

Alveolar microlithiasis is a rare disease with only about 150 cases reported in the literature. Although some patients present with progressive respiratory symptoms, the discovery is in most cases an incidental finding on a chest radiograph. The management of the condition has essentially supportive in all reported cases. We describe a case first discovered in 1976 and finally diagnosed in 1985.

Calculi↗