Outcome of bilateral lung volume reduction in patients with emphysema potentially eligible for lung transplantation.

Objective: Between January 1993 and May 1998, we performed 200 consecutive bilateral lung volume reduction operations. After initial assessment, 99 of these patients were eligible for lung volume reduction and potentially eligible for immediate or eventual lung transplantation on the basis of age and absence of contraindications. All chose to proceed with lung volume reduction surgery.

Transcervical thymectomy for myasthenia gravis.

The authors of this article contend that the transcervical approach for thymectomy allows the safe and complete removal of the thymus and [table: see text] provides equivalent benefit to the patients with regard to opportunity for clinical remission or freedom from progression of the symptoms of MG. The low morbidity and short hospitalization after transcervical thymectomy represent minimal barriers and allow increased willingness of the neurologist to refer a patient for surgical therapy and increased acceptance of the patient towards the recommendations. The authors believe that an early, safe, and complete thymectomy offers all the benefits of surgical removal of the thymus to a patient with MG with minimal risk for morbidity and postoperative pain.

Lung transplantation versus lung volume reduction as surgical therapy for emphysema.

There are currently two surgical therapies aimed at crippling, end-stage emphysema: lung transplantation and lung volume reduction surgery (LVRS). Unfortunately, most emphysema patients are poor candidates for any surgical intervention. The authors favor a meticulous selection process in which indications and contraindications are considered and the best solution is devised for each patient.

Depression and service utilization in elderly primary care patients.

The authors analyzed the relationship between a provider's diagnosis of depression and health services utilization among all elderly patients (N=3,481) seen in a primary care practice over 12 months. Of patients with a diagnosis of depression, 29.7% were given an antidepressant.

Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression.

Objective: The authors' goal was to examine the extent to which perceived stigma affected treatment discontinuation in young and older adults with major depression.

Method: A two-stage sampling design identified 92 new admissions of outpatients with major depression. Perceived stigma was assessed at admission.

Lung transplantation is warranted for stable, ventilator-dependent recipients.

Background: Lung transplantation for patients on ventilators is a controversial use of scarce donor lungs. We have performed 500 lung transplants in 12 years and 21 of these have been in ventilator-dependent patients.

Methods: A retrospective review of patient records and computerized database was performed.

Perioperative complications after living donor lobectomy.

Objective: Clinical lung transplantation has been limited by availability of suitable cadaveric donor lungs. Living donor lobectomy provides right and left lower lobes from a pair of living donors for each recipient. We reviewed our experience with living donor lobectomy from July 1994 to February 2000.

Diagnosis, treatment, comorbidity, and resource utilization of depressed patients in a general medical practice.

Objective: The objective of the study was to determine the effect of depression on the utilization of health care resources, after adjusting for age and comorbidity from data obtained on routine clinical practice.

Method: The study is an observational cohort of 15,186 patients followed over a one-year period beginning December 1993. Comprehensive demographic, clinical, and utilization data were available from the computerized medical information system generated database of a general internal medicine practice in an urban academic medical center.

Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: a ten-year institutional experience.

Objective: Between July 1988 and July 1998, we performed 433 lung transplants. Forty-five patients had idiopathic pulmonary fibrosis, and operations for these patients included 32 single lung transplants and 13 bilateral sequential lung transplants. This study reviews this experience and compares single lung transplantation and bilateral lung transplantation for pulmonary fibrosis.

Selective use of extracorporeal membrane oxygenation is warranted after lung transplantation.

Objectives: Early allograft dysfunction after lung transplantation ranges from subclinical x-ray abnormalities to pulmonary edema, hypoxemia, hypercarbia, and pulmonary hypertension. Management may include extracorporeal circulation to allow recovery of the acute lung injury. We reviewed our experience with extracorporeal membrane oxygenation after lung transplantation to assess the utility of this therapy.

Cefaclor revisited.

Objective: This paper describes the rationale for choosing cefaclor for the management of respiratory tract infections.

Background: Since 1979, cefaclor has established a record of efficacy in the management of respiratory tract infections. Factors contributing to the efficacy and tolerability of this drug include its molecular stability, activity against the most prevalent gram-positive and gram-negative respiratory tract pathogens, rapid absorption, >90% bioavailability, and good penetration into respiratory mucosa.

Executive dysfunction and long-term outcomes of geriatric depression.

Background: This study investigated the relationship of executive and memory impairment to relapse, recurrence, and course of residual depressive symptoms and signs after remission of geriatric major depression.

Methods: Fifty-eight elderly subjects remitted from major depression received continuation nortriptyline treatment (plasma levels 60-150 ng/mL) for 16 weeks and then were randomly assigned to either nortriptyline maintenance therapy or placebo for up to 2 years. Diagnosis was made using the Research Diagnostic Criteria and the DSM-IV criteria after an interview using the Schedule for Affective Disorders and Schizophrenia.

Tuberculosis in orthotopic liver transplant patients: increased toxicity of recommended agents; cure of disseminated infection with nonconventional regimens.

Background: Because increased hepatotoxicity was observed with first line antituberculous agents using four drug standard induction therapy in orthotopic liver transplant patients, we evaluated the efficacy and adverse effects of a novel continuation regimen for the treatment of tuberculosis in orthotopic liver transplant patients at a University Hospital in New York City.

Methods: The hospital records of all patients who were referred to Mount Sinai Hospital (n=924) and who underwent orthotopic liver transplant between September 1988 and May 1998 were reviewed. Data were collected from patient records.

Schizophrenia and older adults. An overview: directions for research and policy.

The Group for the Advancement of Psychiatry, Committee on Aging, believes that a crisis has emerged with respect to the understanding of the nature and treatment of schizophrenia in older persons. Moreover, critical gaps exist in clinical services for this population. In this article, we examine the epidemiology of aging and schizophrenia; life-course changes in psychopathology, cognitive function, social functioning, and physical health; and various concerns regarding treatment, services, and financing.

Selective decontamination of the digestive tract helps prevent bacterial infections in the early postoperative period after liver transplant.

Unlabelled: In liver transplant (LTx) recipients, gut-associated bacterial and fungal organisms produce significant postoperative morbidity and mortality. We sought to assess the role of selective digestive decontamination (SDD) in preventing postoperative infections in a large single-center cohort of liver recipients transplanted under two non-simultaneous protocols. In 212 consecutive patients transplanted between 1/1/91 and 7/31/92, SDD (gentamicin 80 mg, polymyxin B 100 mg, nystatin suspension 10 mL) was employed, starting after induction of anesthesia and continued until POD 21 (SDD Group).

Plant disease resistance genes encode members of an ancient and diverse protein family within the nucleotide-binding superfamily.

The nucleotide binding site (NBS) is a characteristic domain of many plant resistance gene products. An increasing number of NBS-encoding sequences are being identified through gene cloning, PCR amplification with degenerate primers, and genome sequencing projects. The NBS domain was analyzed from 14 known plant resistance genes and more than 400 homologs, representing 26 genera of monocotyledonous, dicotyle-donous and one coniferous species.

The current role of mediastinoscopy in the evaluation of thoracic disease.

Objective: Mediastinoscopy is a common procedure used for the diagnosis of thoracic disease and the staging of lung cancer. We sought to determine the current role of mediastinoscopy in the evaluation of thoracic disease.

Methods: We conducted a retrospective review of all mediastinoscopies performed by members of our service between January 1988 and September 1998.

Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients.

Objective: To review the results of the authors' most recent 100 consecutive cases of transcervical thymectomy for myasthenia gravis (MG) in terms of complications and outcome in comparison with other reported techniques.

Summary Background Data: Myasthenia gravis is believed to be an autoimmune disorder characterized by increasing fatigue with exertion. The role of thymectomy in the management of the disease remains unproven, but there is widespread acceptance of the notion that complete thymectomy improves the course of the disease.

Alpha(1)-acid glycoprotein, age, and sex in mood disorders.

Serum alpha(1)-acid glycoprotein (AAG) reportedly can increase with age in the normal population, especially among women. In 33 patients with unipolar major depression or bipolar disorder, serum AAG was measured by age. The authors noted a positive association with age, particularly in depressed female patients (n=18; r(s)=0.

Lung transplantation: current status and future prospects.

Lung transplantation recently marked its 35th anniversary. The period has been marked by 20 years of initially slow progress followed by 15 years of explosive growth and success. In 1997 the number of lung and heart-lung transplants exceeded 1000 in the United States and 1400 worldwide.

Lung transplantation: a decade of experience.

Objective: To review the 10-year clinical experience of a single institution's adult lung transplant program.

Methods: Since July 1988, 450 lung transplants have been performed in 443 patients. Recipient diagnoses included emphysema in 229 patients, cystic fibrosis in 70 patients, pulmonary fibrosis in 48 patients, pulmonary hypertension in 49 patients, and miscellaneous end-stage lung diseases in 47 patients.