Determination of mortality risk in obstructive pulmonary syndromes: physical examination compared with measurement of forced expired volume in one second.

A standardised physical examination based on four clinical signs was compared with the FEV1 with regard to ability to determine five-year mortality risk in subjects with varying degrees of obstructive airway disease. Both evaluation methods identified low, intermediate, and high risk groups within the population studied. Individuals with no positive physical signs, or with an FEV1 of 70% of predicted or more had mortality not significantly greater than that predicted on the basis of standard mortality tables. There was no difference between the FEV1 and the physical examination in ability to predict mortality.     

The use of quantitative cultures and antibody coating of bacteria to diagnose bacterial pneumonia by fiberoptic bronchoscopy

This study uses quantitative cultures and immunofluorescent demonstration of antibody-coated bacteria to differentiate colonizing from infecting bacteria in lower respiratory secretions obtained by fiberoptic bronchoscopy. The fiberoptic bronchoscope was passed transnasally without the use of a nasotracheal tube, and a single-sheath cytology brush dipped in lower respiratory secretions served as inoculum for quantitative cultures. Secretions were also collected by aspiration through the bronchoscope side channel for fluorescent examination. None of 60 control patients had greater than 4,000 colony-forming units (CFU) per brush of a single bacterium on quantitative culture. In contrast, more than 4,000 CFU per brush were isolated from 29 of 33 episodes of clinically defined lower respiratory infection (p less than 0.001). Only 1 of 60 control patients had antibody-coated bacteria in their lower respiratory secretions, but antibody coating was demonstrated in association with 24 of 33 episodes of infection (p less than 0.001).     

Patient Scenario Identifies Gaps in Breast Cancer Services in a Rural Region

Studies have demonstrated that community-based cancer coalitions can effectively address cancer disparities in rural areas. Scenario plots have been used to assess community needs in health care and public health. The social and medical context of a woman with undetected breast cancer was developed as a patient scenario implemented at a rural cancer coalition meeting to rapidly identify gaps in services. Transportation, fragmentation of cancer care, access to insurance coverage, patient navigation, and survivorship services were identified as gaps in ensuring patient compliance across the continuum of breast cancer care throughout the region. Results will be used to shape coalition priorities.     

Evaluating Medical Home constructs for children with special needs: integrating theory and logic models

The Medical Home model for providing services to children with special healthcare needs has strong philosophical foundations, but the science supporting this theoretical model is not as well developed. The use of logic models and mixed method design provide systematic and rigorous approaches to observation while retaining the complexity, which tends to be lost with research designs intended to control and reduce the number of variables impacting a desired outcome, such as randomized controlled trials. This application provides a historical basis for applying logic models of evaluation and illustrates the utility of logic models.     

Induktion von Arteriogenese in der Peripherie

Arteriogenesis, the growth of preformed collateral arteries into functional conductance vessels, is a natural mechanism, which can be induced in animal models. Elevating the fluid shear stress on vessel endothelium is crucial for arteriogenesis and is generally induced by arterial occlusion. Two models to induce peripheral arteriogenesis are described. Ligating the femoral artery of the mouse hindlimb is a standardised model which leads to collateral growth in the thigh muscles. To enhance the effect of a simple ligature, the shunt-model, which combines the ligature with an arteriovenous fistula of a femoral artery and vein distal to the occlusion, may be employed. As a consequence the blood flow is drained directly into the venous system, causing chronically elevated shear stress and a maximal stimulus for arteriogenesis.     

Endothelial cell damage and tubuloreticular structures in interstitial lung disease associated with collagen vascular disease and viral pneumonia

Lung tissue showing the light microscopic changes of interstitial inflammation and fibrosis was studied electron-microscopically in 11 patients with collagen vascular disease and 26 patients with viral pneumonia. All patients exhibited progressive respiratory insufficiency and had abnormal pulmonary function test results. Endothelial cell cytoplasmic swelling and intracellular tubuloreticular structures were the dominant ultrastructural change in the lungs of both groups. Tubuloreticular structures were identified in peripheral blood lymphocytes in all patients with collagen vascular disease and in 2 with viral pneumonia. Tubuloreticular structures were not identified in the lung tissue from various control patients and in the lymphocytes from patients with idiopathic interstitial pulmonary fibrosis. We conclude that (1) the ultrastructural changes seen in viral pneumonia and collagen vascular-associated interstitial lung disease are essentially identical; (2) endothelial cell damage may be the primary pathologic change associated with both diseases; (3) tubuloreticular structures are seen in large numbers in lung tissue from patients with viral pneumonia and collagen vascular disease; (4) tubuloreticular structures are present in peripheral blood lymphocytes from all patients with collagen vascular disease.     

Idiopathic Fibrosing Alveolitis: A Review with Emphasis on Ultrastructural and Immunohistochemical Features

Fibrosing alveolitis is a usually chronic pulmonary disease affecting middle-aged men and women and causing progressive dyspnea. This review discusses the nosologic, etiologic, immunopathogenic, histologic, immunohistochemical and ultrastructural features of this condition. A hypothesis is presented suggesting microvascular damage as the primary pathologic change in cases associated with collagen vascular diseases and viral pneumonia.     

Studies on the Epidemiology of Escherichia coli Infections. V. Factors Influencing Acquisition of Specific Serologic Groups

Stool carrier rates of Escherichia coli serogroups 4, 6, and 75 were determined on admission and discharge for 190 patients. Persons who were in the hospital 3 weeks or longer had an intestinal carrier rate of 46% compared to a rate of 28% in individuals who had no recent hospital contact. Treatment with broad spectrum antibiotics increased the susceptibility for acquisition of certain specific serologic groups. This was apparently not related to replacement of sensitive E. coli by drug-resistant forms. Studies were made to determine the environmental source for colonization of hospitalized patients and the risk of urinary infection in stool carriers of these strains. A survey of inanimate objects of medical and urological wards demonstrated infrequent isolation of 04, 06, and 075, indicating that extraintestinal foci were an unlikely source for hospital-acquired E. coli. Hemagglutination titers with determination of group-specific O antibody failed to demonstrate any deficiency in hospitalized patients who became colonized with certain coliforms. Similarly, no significant deficit in group-specific serum antibody was found in patients who were community carriers of E. coli 04, 06, or 075. Despite a high rate of acquisition of E. coli serogroups 4, 6, and 75 in the stools of hospitalized patients, only those patients undergoing urinary tract manipulation developed bacteriuria.