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In Reply: Diagnosis of Tuberculosis
112
A. Small Quantities Materials 1) An aliphatic hydrocarbon (petroleum distillate) odorless type or its equivalent is used (degreasing solution). 0 0 2) Washing detergent-eg Dreft. 3) Wide mouthed large capacity jar-l gallon.
COMMUNICATIONS TO THE EDITOR
by Mr. Kittredge is a good one, but probably more expensive than degreasing them in one's own institution. I would like to thank Mr. Kittredge for his interesting letter. Robert S. Deane, M.B., Bch. Burlington, Vermont
Procedure 1) 10-12 "Chore Girls" are placed in the jar, two quarts of degreasing solution added, the jar is capped and shaken vigorously for one minute. 2) Remove the "Chore Girls," allowing excess degreasing solution to drain into the jar and rinse under running water in a sink. 3) Prepare the usual strength washing detergent and wash the "Chore Girls" with a strong "swishing motion." 4) Rinse in running water, shake off the excess, dry and introduce a single copper sponge into the large reservoir nebulizer, or humidifier, which is then gas sterilized with ethylene oxide. Alternatively, eight dry sponges are placed in the Vermont Copper Trap. B. Large Quantities
A Model VS 800 "Little Corporal" de greaser is used which cleans the "Chore Girls" with trichlorethylene solvent vapor, a distillate spray and a pure vapor rinse, a process which takes five minutes. They are then washed in a detergent and rinsed in water and dried.
Tests for Residual Oil Following both cleaning procedures, Chore Girls have been tested to ensure that they are oil free, by Oil Red 0 floatation method and by placing a gauze square soaked with osmic acid over the patient port of the exhalation valve, and leaving the respirator on for a period of hours. No evidence was found of contamination.
Comment The cost of "Chore Girls" is 4Jt¢jeach-36¢ to fill a Vermont Copper Trap. The same material from J. H. Emerson Co., Catalogue No. 3V 159 costs $4.80; the Company have their sponges degreased commercially. Where facilities do not exist for adequate cleaning and degreasing, the alternative suggested OOeg: Thin X, manufactured by Clark Lurton Corporation, Malden, Massachusetts. At our institution, we use mineral spirits purchased by our paint shop from Sun Oil Company at a cost of 45('!!1:allon. The solution may be reused, depending on the amount of dirt and oil encountered.
Diagnosis of Tuberculosis To the Editor: In volume 58, on page 611 (1970) is an article about pulmonary tuberculosis. The article states "sputum was positive for acid-fast bacilli." The diagnostic standards for tuberculosis state that positive microscopy alone is not diagnostic of tuberculosis. The report by Dr. Grillo does not definitely state that the patient had a culture. This woman being Nigerian possibly could have had a diagnosis based on microscopy alone which would be inadequate. Patients with bronchitis or bronchiectasis may occasionally have saprophytes or other mycobacteria which do not represent genuine pulmonary tuberculosis. As this patient did definitely have proved bronchiectasis there are certainly some specialists who would question the diagnosis of tuberculosis in this case, based on the report that was printed. T. H. Biggs, M.D. Medical Director
To the Editor: Many thanks for your letter advising us on the issues raised by Dr. T. H. Biggs, regarding the technicality in the expressions on the diagnosis of tuberculosis on the patient reported in Volume 58, No.6, page 611 of CHEST. From the information that I have here the expression: "sputum was positive for acid-fast bacilli" really means that the patient's sputum was positive on culture for acid-fast bacilli. It is an oversight on our part, and the statement should really have read "sputum was positive on culture for acid-fast bacilli." Isaac A. Grillo, M.D. lbadan, Nigeria CHEST, VOL. 60, NO. I, JULY 1971
A. Small Quantities Materials 1) An aliphatic hydrocarbon (petroleum distillate) odorless type or its equivalent is used (degreasing solution). 0 0 2) Washing detergent-eg Dreft. 3) Wide mouthed large capacity jar-l gallon.
COMMUNICATIONS TO THE EDITOR
by Mr. Kittredge is a good one, but probably more expensive than degreasing them in one's own institution. I would like to thank Mr. Kittredge for his interesting letter. Robert S. Deane, M.B., Bch. Burlington, Vermont
Procedure 1) 10-12 "Chore Girls" are placed in the jar, two quarts of degreasing solution added, the jar is capped and shaken vigorously for one minute. 2) Remove the "Chore Girls," allowing excess degreasing solution to drain into the jar and rinse under running water in a sink. 3) Prepare the usual strength washing detergent and wash the "Chore Girls" with a strong "swishing motion." 4) Rinse in running water, shake off the excess, dry and introduce a single copper sponge into the large reservoir nebulizer, or humidifier, which is then gas sterilized with ethylene oxide. Alternatively, eight dry sponges are placed in the Vermont Copper Trap. B. Large Quantities
A Model VS 800 "Little Corporal" de greaser is used which cleans the "Chore Girls" with trichlorethylene solvent vapor, a distillate spray and a pure vapor rinse, a process which takes five minutes. They are then washed in a detergent and rinsed in water and dried.
Tests for Residual Oil Following both cleaning procedures, Chore Girls have been tested to ensure that they are oil free, by Oil Red 0 floatation method and by placing a gauze square soaked with osmic acid over the patient port of the exhalation valve, and leaving the respirator on for a period of hours. No evidence was found of contamination.
Comment The cost of "Chore Girls" is 4Jt¢jeach-36¢ to fill a Vermont Copper Trap. The same material from J. H. Emerson Co., Catalogue No. 3V 159 costs $4.80; the Company have their sponges degreased commercially. Where facilities do not exist for adequate cleaning and degreasing, the alternative suggested OOeg: Thin X, manufactured by Clark Lurton Corporation, Malden, Massachusetts. At our institution, we use mineral spirits purchased by our paint shop from Sun Oil Company at a cost of 45('!!1:allon. The solution may be reused, depending on the amount of dirt and oil encountered.
Diagnosis of Tuberculosis To the Editor: In volume 58, on page 611 (1970) is an article about pulmonary tuberculosis. The article states "sputum was positive for acid-fast bacilli." The diagnostic standards for tuberculosis state that positive microscopy alone is not diagnostic of tuberculosis. The report by Dr. Grillo does not definitely state that the patient had a culture. This woman being Nigerian possibly could have had a diagnosis based on microscopy alone which would be inadequate. Patients with bronchitis or bronchiectasis may occasionally have saprophytes or other mycobacteria which do not represent genuine pulmonary tuberculosis. As this patient did definitely have proved bronchiectasis there are certainly some specialists who would question the diagnosis of tuberculosis in this case, based on the report that was printed. T. H. Biggs, M.D. Medical Director
To the Editor: Many thanks for your letter advising us on the issues raised by Dr. T. H. Biggs, regarding the technicality in the expressions on the diagnosis of tuberculosis on the patient reported in Volume 58, No.6, page 611 of CHEST. From the information that I have here the expression: "sputum was positive for acid-fast bacilli" really means that the patient's sputum was positive on culture for acid-fast bacilli. It is an oversight on our part, and the statement should really have read "sputum was positive on culture for acid-fast bacilli." Isaac A. Grillo, M.D. lbadan, Nigeria CHEST, VOL. 60, NO. I, JULY 1971