Voluntariness to consent to research in a voluntarily and involuntarily hospitalized psychiatric population.

The purpose of our study was to examine rates of consent to participate in research in voluntarily and involuntarily hospitalized psychiatric patients in order to evaluate factors that may influence the decision to participate in research. We used logistic regression models to evaluate differences and found that involuntary patients were less likely to consent to participate. After adjustment for covariates, we found that consent rates did not differ between the involuntary and voluntary population, but that lower Global Assessment of Functioning (GAF) scores and psychosis negatively affected the decision to consent to research.

Expression of the GM-CSF receptor in ovine spermatozoa: GM-CSF effect on sperm viability and motility of sperm subpopulations after the freezing-thawing process.

The granulocyte-macrophage colony stimulating factor (GM-CSF) is a pleiotropic cytokine capable of stimulating proliferation, maturation and function of haematopoietic cells. Receptors for this cytokine are composed of two subunits, alpha and beta, and are expressed in myeloid progenitors and mature mononuclear phagocytes, monocytes, eosinophils and neutrophils, as well as in other non-haematopoietic cells. We have previously demonstrated that bull spermatozoa express functional GM-CSF receptors that signal for increased glucose and vitamin-C uptake and enhance several parameters of sperm motility in the presence of glucose or fructose substrates.

Transdermal clonidine reduced some withdrawal symptoms but did not increase smoking cessation.

Background: Clonidine may be useful in controlling tobacco withdrawal and in facilitating smoking cessation. This study was developed to test the efficacy of transdermal clonidine in promoting smoking cessation.

Methods: We conducted a five-center, double-blind, placebo-controlled, randomized controlled trial of transdermal clonidine in conjunction with a minimal behavioral intervention for smoking cessation.

Dose response to ipratropium as a nebulized solution in patients with chronic obstructive pulmonary disease. A three-center study.

We performed a dose-response study of ipratropium bromide as a nebulized solution in patients with stable chronic obstructive pulmonary disease (COPD) using a double-blind crossover format. Five doses from 0.05 to 0.

Mild emphysema is associated with reduced elastic recoil and increased lung size but not with air-flow limitation.

Thirty-nine excised human lungs were examined to identify early changes in the small airways, their size distribution, and their elastic recoil in relation to mild degrees of emphysema. Elastic recoil measurement, single-breath nitrogen (SBN2) tests, and FEV1 were obtained from 18 lungs with no emphysema and 21 emphysematous lungs with no greater than Grade 5 emphysema score. The mean number of alveolar attachments per brochiole was determined from all the bronchioles cut in cross section.

Radial traction and small airways disease in excised human lungs.

We studied 47 excised human lungs in order to examine the relationship between the number of alveolar attachments surrounding bronchioles 2 mm or less in diameter and the presence of small airways disease and overall lung function. Expiratory pressure-volume curves, the FEV1, and the single-breath nitrogen washout were obtained from 11 lungs without emphysema and 36 lungs with various degrees of emphysema. The lungs were subsequently inflation-fixed at 20 cm H2O.

The lungs and causes of death in the nocturnal oxygen therapy trial.

Autopsy findings and a morphometric study of the lungs were compared in 18 subjects receiving nocturnal oxygen and 15 receiving continuous oxygen in the National Heart, Lung, and Blood Institute Nocturnal Oxygen Therapy Trial (about half of those who died). The emphysema score, average interalveolar wall distance, central airway lesions, peripheral airway lesions, and the ratio of weights of left ventricle plus septum to right ventricle were similar in the two groups. The causes of death in the two groups were also similar.

Small airway disease is associated with elastic recoil changes in excised human lungs.

We studied 54 excised human lungs, 15 with no emphysema and 39 with varying degrees of emphysema, to examine the relationship of small airway disease and elastic recoil. We found a negative correlation between the total small airway pathology score and the mean internal bronchiolar diameter (r = -0.309, p = less than 0.

Sonographic identification of lung maturation in the fetal lamb.

Ultrasound evaluation of fetal lung development in utero could be a noninvasive method for frequent monitoring of the state of pulmonary maturity and predicting when parturition could occur with minimum or no risk of respiratory distress syndrome of the newborn. In cases of high-risk obstetric management in premature labor, this ability may be a particularly useful tool. To pursue this possibility, the lungs and livers of 13 living fetal lambs were successfully imaged with a modified clinical B-scanner under carefully controlled conditions; physiologic function tests on the excised lungs determined the state of pulmonary maturity.

Small airway dimension and size distribution in human lungs with an increased closing capacity.

Pulmonary function tests were obtained in 7 emphysema-free and 27 emphysematous lungs with minimal small airway disease. The lungs were divided into 2 groups on the basis of whether they had a small or large, i.e.

The morphology and morphometry of small airways disease (relevance to chronic obstructive pulmonary disease).

The morphologic and morphometric characteristics of the small airways of the lung and their relationship to airflow as measured by forced expiratory volume in one second (FEV1) were determined in 37 excised human lungs. After fixation the lungs were graded as to the degree of emphysema and the degree of small airway pathology. The internal diameters of the small airways were measured and corrected for shrinkage during processing.

Functional correlations with mild and moderate emphysema in excised human lungs.

The relation between mold to moderate emphysema and lung function tests, including tests reported to identify "early" or mild disease, were examined using 24 excised human lungs, 5 with no emphysema, 11 with grade 5 or less emphysema, and 8 with as much as grade 50 emphysema. Static pressure volume curves, single breath nitrogen (SBN2) tests, maximal exemphysema. Static pressure volume curves, single breath nitrogen (SBN2) tests, maximal expiratory flow volume (MEFV) curves with air and a mixture of 80% He and 20% O22, and forced expiratory volume in one second (FEV1) were measured in all lungs.

Diagnosis of adult respiratory distress syndrome associated with underlying severe emphysema.

Adult respiratory distress syndrome (ARDS) notably produces bilateral homogeneous alveolar infiltrates and decreased lung compliance. We encountered a patient whose severe underlying emphysema altered these distinctive clinical features. The chest roentgenogram showed bilateral infiltrates containing multiple radiolucencies that simulated a cavitary process.

Elastic recoil changes in early emphysema.

An attempt was made to determine if emphysema and static lung recoil were related in a group of 65 excised human lungs. We studied 23 normal lungs, 24 lungs with an emphysema score of 5 or less, and 18 lungs with an emphysema score greater than 5. A comparison of the percentage of predicted elastic recoil revealed that both emphysema groups were significantly different from normal lungs.

The elastic properties of lobes of excised human lungs.

Static pressure-volume curves were obtained from the upper and lower lobes of 5 excised human lungs. Comparison of the upper and lower lobe pressure-volume curves showed a small but significant difference. The upper lobes contained a greater percentage of total lobar capacity above approximately 80 per cent of the lung volume.

Abnormalities in lung elastic properties and surfactant function in adult respiratory distress syndrome.

We have examined the lungs from five patients who died with the adult respiratory distress syndrome (ARDS). Pressure volume curves were obtained and bronchoalveolar lavage fluid was studied on a surface balance. The pressure volume curves revealed reduced compliance compared to normal or near normal lungs.

Effect of increased static lung recoil on ventilation distribution in excised human lungs.

The contour of a modified Fowler single-breath nitrogen washout was determined in 15 postmortem human lungs before and after static lung recoil had been increased by ventilation. Before ventilation, expiratory nitrogen versus volume curves exhibited the 4 phases similar to those seen in intact human lungs. The tests were repeated after ventilation with humidified air at room temperature for 3 hours at pleural pressures between -20 and +10 cm H2O at 15 breaths per min.

Characteristics of pulmonary surfactant in adult respiratory distress syndrome associated with trauma and shock.

Broncho-alveolar lavage fluid was obtained from a 24-year-old man who developed the adult respiratory distress syndrome one day after massive trauma and hemorrhagic shock. The lungs were available 3 days later when organ transplantation was performed. When the various fractions of the lavage material obtained by centrifugation, including the purified surface-active lipid-protein aggregates, were examined on the film balance, they revealed the usual minimal surface tension of 16 to 18 dyne per cm at 37 degrees C, but the compressibility of the films from the lungs with adult respiratory distress syndrome was 5 to 10 times higher than the normal range.

The morphologic features of the bronchi, bronchioles, and alveoli in chronic airway obstruction: a clinicopathologic study.

A 6-year semiquantitative clinicopathologic study revealed that among 196 men and 46 women 40 or more years of age at death, the severity of destructive emphysema was overwhelmingly the most important morphologic correlate of the clinical state of chronic airway obstruction. The pathogenic mechanisms whereby emphysema may lead to airway obstruction are probably multifactorial, but our data are consistent with a growing consensus that loss of small airway support by surrounding lung tissue in emphysema may cause kinking, tortuosity, and collapse of the airways, with subsequent increased airflow resistance and clinical obstruction. Pathologic changes (inflammation, fibrosis, increased goblet cells, and mucous gland enlargement) in large or small airways in the absence of much emphysema were very seldom associated with significant chronic airway obstruction, and correlated rather poorly with chronic airway obstruction, regardless of severity of emphysema.

The right ventricle in chronic airway obstruction: a clinicopathologic study.

In men 40 or more years of age at death, the upper limits of normal (means plus 2 SD) cardiac ventricular weights were 69 g for the right ventricle and 203 g for the left ventricle plus septum. Right ventricular thickness, as usually determined at autopsy, was a relatively poor index of hypertrophy. When one ventricle hypertrophies as a result of stress, the other tends to enlarge simultaneously, even if no stress on it has been evident.

Bronchoconstriction and pulmonary hypertension during abortion induced by 15-methyl-prostaglandin F2alpha.

Patients have experienced severe breathlessness during second trimester abortion initiated by the intramuscular injection of 15-methyl-prostaglandin F2alpha (15-me-PGF2alpha). In four healthy women given 400 mug of 15-me-PGF2alpha to induce abortion, pulmonary function tests showed reductions in arterial oxygen tension, maximum expired air flow and vital capacity. Residual lung volume and the slope of phase III of the closing volume curves increased.