Pneumonia and ARDS in patients receiving mechanical ventilation: diagnostic accuracy of chest radiography.

This study was done to evaluate the diagnostic accuracy of bedside chest radiography for pneumonia, adult respiratory distress syndrome (ARDS), or both in patients receiving mechanical ventilation. The series consisted of 40 patients; diagnostic accuracy was defined as the area under the receiver operating characteristic curve. Overall diagnostic accuracy for ARDS was 0.

Diagnosis of ventilator-associated pneumonia.

Ventilator-associated pneumonia is a frequent complication of mechanical ventilation, and it carries a significant added mortality. Proper recognition and treatment of pneumonia are associated with improved outcome. Clinical manifestations of pneumonia, chest radiograph findings, and routine analysis of the tracheal aspirate are inadequate, alone or in combination, in diagnosing pneumonia.

New functional zonation in the ovary as shown by immunohistochemistry of luteinizing hormone receptor.

Monoclonal anti-LH receptor antibodies were used to study receptor distribution in the various structures of porcine ovary. Primordial and primary follicles were not labeled. Immunoreactivity appeared on the thecal cells of secondary follicles of approximately 100-200 microns in diameter.

Management of bacterial pneumonia in ventilated patients. Protected bronchoalveolar lavage as a diagnostic tool.

We conducted a prospective study to determine the effectiveness of protected bronchoalveolar lavage (PBAL) in diagnosing pneumonia in ventilated patients and the usefulness of bronchoscopic data in treating ventilated patients. Entrance criteria were (1) fever and a new or progressive infiltrate on chest roentgenogram with either leukocytosis or a macroscopically purulent tracheal aspirate, and (2) no antibiotic therapy for at least 48 h before bronchoscopy. Twenty-five ventilated patients met entrance criteria for the study and completed the protocol.

Pulmonary manifestations of acquired immunodeficiency syndrome.

In at least 65% of patients with acquired immunodeficiency syndrome (AIDS), the lung is the site for life-threatening illness. To establish a basis for understanding the pulmonary pathology of such illness, we first review briefly the effects of the human immunodeficiency virus on the immune system and then review the pathological pulmonary processes occurring in AIDS in terms of their various etiologies: infections, idiopathic processes, and neoplasia. In the section on each etiology, we discuss clinical manifestations, pulmonary pathology, diagnostic findings, and therapeutic options.

[LH and TSH receptors. A new family of G protein-coupled receptors].

Monoclonal antibodies have been raised against porcine LH receptor and allowed to clone the corresponding messenger RNA from testicular cells. Cross hybridisation with the LH receptor clone allowed to isolate a clone corresponding to the human TSH receptor from thyroids. The structure of both receptors have been determined.

Human acrosome biogenesis: immunodetection of proacrosin in primary spermatocytes and of its partitioning pattern during meiosis.

Proacrosin biosynthesis timing during human spermatogenesis has been studied using the monoclonal antibody 4D4 (mAb 4D4). Frozen and paraffin-embedded sections of testicular biopsies were labelled by standard indirect immunofluorescence and avidin-biotin immunoperoxidase procedures. The labelling specificity was checked by immunochemistry assays on unrelated tissues and by western blotting of testis extracts showing that only the 50-55 x 10(3) Mr proacrosin was recognized by mAb 4D4.

Bilateral bronchoalveolar lavage in the diagnosis of opportunistic pulmonary infections.

To further improve the diagnostic value of bronchoscopy in the immunosuppressed population presenting with diffuse pulmonary infiltrates, we prospectively investigated the utility of bilateral bronchoalveolar lavage (BAL). We performed 62 bronchoscopies on 52 immunosuppressed patients. Of the 52 patients, 33 had pulmonary infections.

Fibroproliferative phase of ARDS. Clinical findings and effects of corticosteroids.

Most patients with adult respiratory distress syndrome (ARDS) survive the initial insult which caused respiratory failure only to succumb later to sepsis caused by nosocomial pneumonia or to pulmonary fibrosis. Clinical criteria and analysis of the tracheal aspirate are notoriously inadequate for establishing a diagnosis of ventilator-associated pneumonia. We implemented a comprehensive diagnostic protocol to determine the cause of sepsis in ARDS patients who had been ventilated for more than three days and who had no bronchoscopic evidence of pneumonia.

Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure.

Mechanically assisted intermittent positive-pressure ventilation effectively provides ventilatory support in patients with respiratory failure but it requires placing an artificial airway. We have previously reported our successful experience delivering mechanical ventilation via a face mask (FMMV) rather than with an endotracheal tube in a pilot study of patients with acute respiratory failure. The present investigation evaluated an additional 18 patients with hypercapnic respiratory failure to determine the efficacy of FMMV in a more homogeneous group and to determine factors predicting its success.

Protected bronchoalveolar lavage. A new bronchoscopic technique to retrieve uncontaminated distal airway secretions.

We tested the effectiveness of protected bronchoalveolar lavage (PBAL), performed through a protected transbronchoscopic balloon-tipped (PBT) catheter, in collecting distal airway secretions with a minimal degree of contamination. The PBAL had less than or equal to 1% squamous epithelial cells in 91% of specimens and an absence of bacterial growth in 59% of patients without pneumonia. Using a threshold of 10(4) cfu/ml we had one false positive result in 33 patient without pneumonia and one false negative in 13 patients with pneumonia.

Characterization of rat epithelial epididymal cells purified on a discontinuous Percoll gradient.

A method for the purification of epithelial cells from the three anatomical regions of the rat epididymis (corpus, caput and cauda) is described. An enzymic digestion followed by sedimentation of crude cell suspension on discontinuous Percoll gradient yielded quite pure active epithelial cell population as judged by morphological and functional studies. Electron microscopy analysis showed that cells from bands corresponding to densities 1.

Cytomegalovirus neuropathy in acquired immunodeficiency syndrome: a clinical and pathological study.

We have observed typical cytomegalovirus cytopathology associated with multifocal inflammatory and necrotic lesions of peripheral nerve in biopsy specimens from 4 patients who developed a rapidly progressive, multifocal neuropathy late in the course of human immunodeficiency virus infection. The inflammatory infiltrates, which contained numerous polymorphonuclear cells, were associated with mixed, axonal, and demyelinative lesions of nerve fibers. One of these patients improved on treatment with DHPG (9-[2-hydroxy-l(hydroxymethyl) ethoxymethyl] guanine) and remains stable after 18 months.

Noninvasive face mask ventilation in patients with acute respiratory failure.

Noninvasive face mask ventilation has been used successfully in patients with paralytic respiratory failure. This study evaluated whether noninvasive face mask ventilation can be used for patients with acute respiratory failure due to intrinsic lung disease. Six patients with hypercapnia and four with hypoxemic acute respiratory failure met clinical and objective criteria for mechanical ventilation, which was delivered with pressure control and pressure support via a tightly strapped, clear face mask.

Quantitative study of centrolobular hepatic fibrosis in alcoholic disease before cirrhosis.

In an attempt to determine the importance of perivenular fibrosis (PVF) in alcoholic liver disease, we studied 71 liver biopsies using histological grading and a morphometric method. The histological grading used 7 variables which allowed us to classify the patients into 7 groups: controls, patients without alcoholic hepatitis but with steatosis, steato-fibrosis, portal fibrosis and patients with mild, moderate, or severe alcoholic hepatitis. The quantitative analysis examined 3 parameters: (1) The inner diameter of the terminal hepatic veins (THV).

Pulmonary function tests.

The clinical significance of pulmonary function tests (including blood gas analysis) lies in their sensitivity for detecting PCP. PCP has most consistently been found to cause abnormalities in the DLCO and the exercise arterial blood gas; both are highly sensitive for the presence of Pneumocystis infection. These tests are more sensitive for the detection of PCP than are the resting arterial blood gas and chest x-ray.