Nonrespiratory Stenotrophomonas maltophilia infection at a children's hospital.

To describe Stenotrophomonas maltophilia infection in children, we reviewed the medical records of patients with isolates from nonrespiratory sites and identified 85 episodes, 51 (60%) of which represented true infection. Forty-two episodes (82.4%) were hospital acquired.

Is insurance a more important determinant of healthcare access than perceived health? Evidence from the Women's Health Initiative.

Our objectives were to explore health insurance status and insurance type, adjusted for self-reported and perceived health variables, as determinants of having and using a usual care provider in the Women's Health Initiative (WHI) Observational Study (OS). This analysis describes insurance status in a large, diverse group of older women and tests the hypothesis that insurance was a key predictor of their access to healthcare in the mid-1990s. Multiple logistic regression analysis was used to evaluate determinants of having visited a usual healthcare provider within the proceeding 12 months, using cross-sectional information provided by a population-based cohort of 55,278 postmenopausal women.

Pneumococcal facial cellulitis in children.

Objective: To review the epidemiology and clinical course of facial cellulitis attributable to Streptococcus pneumoniae in children.

Design: Cases were reviewed retrospectively at 8 children's hospitals in the United States for the period of September 1993 through December 1998.

Results: We identified 52 cases of pneumococcal facial cellulitis (45 periorbital and 7 buccal).

Pneumococcal mastoiditis in children.

Objective: To determine the impact of antibiotic resistance on the frequency, clinical features, and management/outcome of mastoiditis attributable to Streptococcus pneumoniae.

Design: Retrospective review of the medical records of children with mastoiditis caused by S pneumoniae from September 1993 through December 1998.

Patients: Infants and children with pneumococcal mastoiditis cared for at 8 children's hospitals in the United States.

K(ATP) channel activation reduces the severity of postresuscitation myocardial dysfunction.

Postresuscitation myocardial dysfunction has been recognized as a leading cause of the high postresuscitation mortality rate. We investigated the effects of ischemic preconditioning and activation of ATP-sensitive K(+) (K(ATP)) channels on postresuscitation myocardial function. Ventricular fibrillation (VF) was induced in 25 Sprague-Dawley rats.

The importance of health insurance as a determinant of cancer screening: evidence from the Women's Health Initiative.

Background: Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initia tive Observational Study cohort.

Methods: Questionnaire data from 55,278 women en rolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years.

Predictors of mortality in children hospitalized with dysentery in Harare, Zimbabwe.

Objectives: To document the pattern of complications and identify risk factors for subsequent mortality in a hospitalized paediatric population during a Shigella dysenteriae type 1 epidemic.

Design: Hospital based prognostic study.

Setting: Paediatric wards in Harare and Parirenyatwa tertiary referral hospitals.

Home-based mother's record: operational feasibility, understanding and usage in a rural community in Zimbabwe.

Utilization of health services is variable but may contribute to the well being of women during pregnancy. If people understand when there is a risk of illness or death, they are likely to cooperate in reducing those risks and participate in their own care. In rural communities people need to be provided with simple but scientifically-sound technology adapted to their understanding and needs.

Streptococcus pneumoniae in the USA: in vitro susceptibility and pharmacodynamic analysis.

Ninety-two laboratories in the USA submitted isolates of Streptococcus pneumoniae to a single laboratory for susceptibility testing. Overall, 64% of 4489 isolates were susceptible to penicillin, 24% were intermediate and 13% were resistant to penicillin, although susceptibilities varied depending on geographical region. Macrolide/azalide resistance varied from 4 to 30%, with some regions having macrolide/azalide resistance higher than penicillin resistance.

The use of water-soluble contrast in evaluating clinically equivocal small bowel obstruction.

This study seeks to determine whether a 6-hour abdominal radiograph after oral Gastrografin is a reliable indicator for nonoperative treatment in patients with a clinically equivocal small bowel obstruction. We collected retrospective data from medical records. Patients who received a Gastrografin transit time (GGTT) study between January 1995 and September 1998 were included in the study.

Four studies of crisis in parents of prematures. 1965.

The responses of 86 families to the birth of a premature baby have been investigated in four linked studies in order to refine the concept and understanding of crisis. Patterns of the grappling behavior during the crisis were identified which enabled accurate predictions of the short-term mental health outcome. Psychological tasks presented by the stress of premature delivery were also identified.

Combined effects of buffer and adrenergic agents on postresuscitation myocardial function.

Although buffer agents alone have failed to improve the success of resuscitation, we now examine the widely held concept that it is the combined effect of alkaline buffer and adrenergic agents that improves outcomes of cardiopulmonary resuscitation. In the present report, the effects of both CO(2)-consuming and CO(2)-generating buffer agents in combination with adrenergic vasopressor drugs were investigated. Ventricular fibrillation was electrically induced in Sprague-Dawley rats weighing between 450 and 550 g.

Ileal [correction of ilial] transposition and enteroglucagon/GLP-1 in obesity (and diabetic?) surgery.

Background: This is a review of intestinal glucagon, which is released when undigested food is in the terminal ileum.

Methods And Results: In the early 1980s, Koopmans and Sclafani showed in fat rats that the transposition of a short segment of ileum to the duodenum would decrease weight just as effectively as intestinal bypass. Sarson and coworkers found elevated enteroglucagon after biliopancreatic diversion (BPD).

Laparoscopic repair of bilateral and recurrent hernias.

The optimal inguinal hernia repair has been controversial for decades. Since the advent of minimally invasive surgery, laparoscopic techniques have added to the controversy. Laparoscopic hernia repair has been advocated by many experts for the repair of bilateral and recurrent inguinal hernias.

Comparison of laparoscopic and open ventral herniorrhaphy.

The repair of large and/or recurrent ventral hernias is associated with significant complications and a recurrence rate that can be more than 50 per cent. Laparoscopic ventral herniorrhaphy, a recent development, has been shown to be safe and effective in the repair of ventral hernias. This study retrospectively reviews all ventral hernia repairs over a 3-year period, November 1995 through December 1998, at a community-based teaching hospital.

Recombinant adeno-associated virus purification using novel methods improves infectious titer and yield.

Conventional methods for rAAV purification that are based on cesium chloride ultracentrifugation have often produced vector preparations of variable quality and resulted in significant loss of particle infectivity. We report here several novel purification strategies that involve the use of non-ionic iodixanol gradients followed by ion exchange or heparin affinity chromatography by either conventional or HPLC columns. These methods result in more than 50% recovery of rAAV from a crude lysate and routinely produce vector that is more than 99% pure.

In vitro activities of the oxazolidinone compounds linezolid (PNU-100766) and eperzolid (PNU-100592) against middle ear isolates of Streptococcus pneumoniae.

Two hundred and sixteen isolates of Streptococcus pneumoniae recovered between 1994 and 1996 from the middle ears of children with acute otitis media were tested for their susceptibility to penicillin, erythromycin, clindamycin and the oxazolidinones, linezolid (PNU-100766) and eperezolid (PNU-100592). There were 116 isolates from the Children's Hospital of Pittsburgh and 100 isolates from a national collection. Eighty percent of the local strains were susceptible to penicillin (MIC < 0.

Laparoscopy for diagnosis and staging of malignancy.

The use of minimally invasive surgery for abdominal pathology, including malignancy, has increased significantly within the past decade. Despite the advances in radiographic imaging, the use of laparoscopy for diagnosing and staging abdominal malignancy has become an important tool in the overall care of these patients. A review of published series for a variety of abdominal malignancies is presented.

Epidemiological analysis defining concurrent outbreaks of Serratia marcescens and methicillin-resistant Staphylococcus aureus in a neonatal intensive-care unit.

Objective: To describe the epidemiology, interventions, and molecular typing methods used during the investigation and control of concurrent outbreaks of Serratia marcescens and methicillin-resistant Staphylococcus aureus (MRSA) infections in a neonatal intensive-care unit (NICU).

Setting: A 206-bed women's and infants' hospital with a 48-bed NICU.

Design: A 22-week, prospective, descriptive study of all NICU infants with S marcescens or MRSA infection or colonization.

Decreases in organ blood flows associated with increases in sublingual PCO2 during hemorrhagic shock.

Earlier studies demonstrated that not only the stomach but also the esophageal wall served as an appropriate site for estimating the severity of circulatory shock by using tonometric methods. We then conceived of the option of sublingual tonometry. In the present study, we tested the hypothesis that the changes in sublingual PCO2 serve as indicators of decreases in blood flow to sublingual and visceral tissue.