A "closed" medical intensive care unit (MICU) improves resource utilization when compared with an "open" MICU.

We hypothesized that a "closed" intensive care unit (ICU) was more efficient that an "open" one. ICU admissions were retrospectively analyzed before and after ICU closure at one hospital; prospective analysis in that ICU with an open ICU nearby was done. Illness severity was gauged by the Mortality Prediction Model (MPM0).

Primary pulmonary hypertension in a patient with CD8/T-cell large granulocyte leukemia: amelioration by cladribine therapy.

We report a case of primary pulmonary hypertension in an adult man with CD8/T-cell large granulocyte leukemia. Successful treatment of his leukemia with cladribine resulted in dramatic and sustained improvement of his pulmonary hypertension.

Performance on the internal medicine second-year residency in-training examination predicts the outcome of the ABIM certifying examination.

For 223 residents from eight teaching hospitals, the results of the second-year in-training examination and the first-sitting certifying examination of the American Board of Internal Medicine were highly correlated. The results of the in-training examination can serve residents as an important measure of their preparedness for certification and can be useful in identifying the need for more intensive self-study strategies during the subsequent one and a half years.

Pulmonary and critical care medicine.

Although it is still unknown how much CPAP use is sufficient to prevent daytime hypersomnolence in obstructive sleep apnea syndrome, sleeping without CPAP for one night reversed the beneficial effects of 1 month of CPAP use. The assessment of tissue pH is relatively easy in hollow organs by means of tonometry.

Effects of dobutamine on oxygen transport and consumption in the adult respiratory distress syndrome.

Objective: To determine if oxygen consumption (VO2) in patients with adult respiratory distress syndrome (ARDS) is dependent on, and thus limited by, oxygen transport (TO2) rather than O2 demand.

Design: Prospective study.

Setting: Intensive care unit of a tertiary referral center.

Inclusion body myositis as a cause of respiratory failure.

Inclusion body myositis (IBM) is a slowly progressive myopathy that has not been reported to affect respiratory muscles. It is often refractory to treatment and a muscle biopsy specimen is necessary for the diagnosis. This is a report of a patient with IBM who quickly progressed to respiratory muscle failure requiring intubation.

Intensive one-week orientation for foreign medical graduates entering an internal medicine residency program.

The authors describe an intensive week-long introduction to hospital-based medical practice for foreign medical graduates (FMGs) entering an internal medicine residency program. The intensive orientation helps the FMGs function more effectively in the American hospital environment and reduces the frequency of personal and professional adjustment problems. The program is easily adaptable to other hospitals with large numbers of FMG residents.

Adequacy of tissue oxygenation.

Objective: This paper reviews presently available techniques for monitoring the adequacy of tissue oxygenation, emphasizing the practical and theoretical problems that exist with presently used measurements.

Data Sources: The data are based on a review of the literature.

Data Synthesis: Most of the presently available techniques focus on global measurements of oxygen transport and utilization that may be insensitive to changes occurring in vital tissues critically important to overall homeostasis.

Autoantibodies in patients with primary pulmonary hypertension: association with anti-Ku.

Purpose: Patients with primary pulmonary hypertension (PPH) frequently have Raynaud's phenomenon, serum antinuclear antibodies (ANAs), and/or pulmonary vascular lesions similar to those seen in certain connective tissue diseases, especially scleroderma. A number of relatively disease-specific autoantibodies have been described in connective tissue diseases but have not been studied in patients with PPH. Therefore, sera from PPH patients were studied for a variety of autoantibodies, seeking a possible link between this pulmonary disorder and connective tissue diseases.

Comparison of gastric intramucosal pH with measures of oxygen transport and consumption in critically ill patients.

Objective: To determine the relationship of tonometrically measured gastric intramucosal pH to clinically accepted indices of systemic oxygenation.

Design: Prospective, nonintervention study.

Setting: Medical and surgical ICUs of a university hospital.

Reversible brain death. A manifestation of amitriptyline overdose.

Tricyclic antidepressants are known to cause central nervous system depression. However, a generalized depression of brainstem functions is rarely reported. We report a patient in deep coma with complete absence of brain-stem reflexes after she had taken a large quantity of amitriptyline.

Oxygen supply and utilization relationships. A reevaluation.

The relationship between oxygen transport (TO2) and oxygen consumption (VO2) has been studied in patients with a number of acute and chronic disorders. Many of these patients have been shown to have a linear relationship between these two variables over a wide range of TO2, which has been considered as evidence of pathologic supply dependency. This supply dependency contrasts with animal studies that have clearly demonstrated a biphasic relationship between TO2 and VO2.

Oxygen delivery and utilization.

Under normal circumstances, O 2 transport (TO 2 = cardiac output x arterial O 2 content) is regulated to provide sufficient O 2 to meet the demands of oxidative phosphorylation, quantified as the O 2 consumption (VO 2). When metabolic demands increase, TO 2 is augmented and in addition, the fractional extraction of the delivered O 2 by the tissues, the O 2ER, also increases, to levels as high as 0.80 at maximum VO 2.

Oxygen transport and utilization in ARDS.

The process of tissue O2 transport and utilization is complex and incompletely understood. It depends on the successful interaction of the respiratory and cardiovascular system in order to deliver O2 in sufficient amounts and at a high enough capillary partial pressure to allow for adequate diffusion into the cell. Normally, adequate amounts of O2 are available and the system can easily augment transport to meet increased metabolic demands.

Clinical role of bronchoalveolar lavage in adults with pulmonary disease.

BAL remains a powerful investigative tool. In a short span of 20 yr, it has helped tremendously in understanding some of the aspects of the pathogenesis of diseases involving the lower respiratory tract. To realize its full potential in the diagnosis and management of diseases involving the lower respiratory tract, there is a great need for standardization of the technical aspects of BAL as well as processing and analysis of the BAL cellular- and fluid-phase components.

Vasodilators and primary pulmonary hypertension. Variability of long-term response.

Long-term response to vasodilator therapy was assessed in six patients with PPH. Following an acute trial, each patient was restudied after (1) two months of drug administration, (2) one month of abstinence from therapy, and (3) an additional two months of therapy. Three of six patients had no long-term reduction of PVR after treatment; one showed a progressive increase.