Nosocomial colonization and infection in persons infected with human immunodeficiency virus.

Nosocomial infections appear to be increased in patients with acquired immunodeficiency syndrome (AIDS), compared to individuals with asymptomatic infection due to human immunodeficiency virus (HIV). Risk factors for bacterial colonization and infection include immunosuppression, prior treatment with some antibiotics, increased hospitalizations with longer lengths of stay, greater exposure to invasive devices such as indwelling intravenous or urinary catheters, and the degree of immunosuppression. Data suggest that other infectious agents such as Pneumocystis carinii, Mycobacterium tuberculosis, Mycobacterium avium complex, and Cryptosporidium may be acquired in healthcare facilities.

Artificial airways: a survey of cuff management practices.

Objective: To determine current endotracheal and tracheostomy tube cuff management practices in adult and pediatric populations, and to compare current adult cuff management practice with those reported in use in 1984 and 1987.

Design: Descriptive survey.

Setting: Sixty-four acute care hospitals in the northeastern United States.

Penetrating thoracic trauma in a pediatric population.

Introduction: Penetrating thoracic trauma in the pediatric population is increasing at an alarming rate. We sought to describe this population and to define prognostic factors that might be of benefit in the management of these patients.

Methods: We retrospectively reviewed the charts and trauma registry records of 65 patients 18 years of age and younger admitted to an urban level I trauma center with the diagnosis of penetrating thoracic trauma.

High levels of CA-125 in a case of a parasitic leiomyoma presenting as an abdominal mass.

A 32-year-old woman presented with increasing abdominal girth and discomfort secondary to a 18-week-size mass and a CA-125 level of 1539. She underwent an exploratory laparotomy and resection of a parasitic fibroid following which the CA-125 levels decreased and normalized within a month. A review of English literature indicates that association of raised CA-125 levels with fibroids is inconsistent and very modest and such high levels have not been previously reported.

Leiomyoma of the breast.

Leiomyoma is the most uncommon benign neoplasm of the breast. We report a case of a middle-aged woman with a palpable breast mass who underwent excisional biopsy. Pathologic examination revealed a leiomyoma.

Gastrointestinal and nutritional problems in children with immunodeficiency and AIDS.

Immunodeficient children pose a challenge to clinicians because of the interrelationship between infectious disease, metabolism, gastrointestinal tract function, psychosocial problems, and immune function. The interplay between these factors is not always clear, and frequently the best course of therapy is obscured because of an inability to determine which factors have the greatest impact on child health. To optimize therapeutic intervention, a multidisciplinary health care team must be involved with the management of children and their families.

Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996.

Mechanically ventilated patients have a higher incidence of pneumonia and mortality than do nonventilated patients. Ventilator-associated pneumonia (VAP) is diagnosed clinically, by bronchoscopy or "blind" bronchoalveolar lavage (BAL) or protected specimen brush (PSB), and by quantitative endobronchial aspirates (QEA). VAP is usually caused by bacteria, but Legionella pneumophila, Mycobacterium tuberculosis, viruses, and fungi are also potential pathogens.

Neisserial porins induce B lymphocytes to express costimulatory B7-2 molecules and to proliferate.

The neisserial porins are the major protein components of the outer membrane of the pathogenic Neisseria (N. meningitidis and N. gonorrhoeae).

Treatment of 100 patients with primary amyloidosis: a randomized trial of melphalan, prednisone, and colchicine versus colchicine only.

Purpose: A clinical trial designed to test whether treatment with melphalan, prednisone, and colchicine (MPC) is superior to colchicine (C) alone was performed in patients with primary amyloidosis (AL), a nonmalignant plasma cell dyscrasia.

Patients And Methods: Patients were randomized to MPC or C with stratification according to sex, time from diagnosis to study entry (ie, less than 3 months or 3 to 12 months), and dominant organ system involvement (ie, cardiac, renal, neurologic, or others). Data were gathered monthly from patients, quarterly from physicians, and annually in the Clinical Research Center.

The experience of violent injury for young African-American men: the meaning of being a "sucker".

Objective: To explore the experience of violent injury among young African-American men with gunshot or stab wounds to better understand violent injury.

Design: Convenience sample, using open-ended, semistructured interviews.

Setting: An urban, municipal hospital in Boston.

New concepts in the pathophysiology and management of middle ear disease in childhood.

Middle ear disease encompasses acute otitis media, recurrent otitis media, and otitis media with effusion. For many children, middle ear disease occurs early in life, is chronic and recurrent and can impair language development and/or school performance. Risk factors for recurrent otitis media include early disease onset, bottle feeding, daycare attendance, exposure to cigarette smoke and immunological defects or immaturity.

Drug effects: a search for outcomes.

In order to best understand the developmental and behavioral effects of prenatal cocaine exposure, two important activities must occur. The first is the continuing development and refinement of research methodologies. Information-sharing activities such as conferences support this goal.

Treatment of high-energy proximal tibial fractures using the Monticelli-Spinelli external fixator: a preliminary report.

Between 1990 to 1993, 21 patients with tibial plateau or proximal tibial fractures resulting from high-energy trauma were treated with the Monticelli-Spinelli external fixator. There were 13 men and 8 women (mean age, 45.2 years; range, 26 to 78).

Validating literature-based models with direct clinical trial results: the cost-effectiveness of secondary prophylaxis for PCP in AIDS patients.

Objective: To compare literature-based estimates of the cost-effectiveness ratios of strategies for secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) in AIDS patients with estimates obtained using data from a recent comparative clinical trial.

Design: A decision-analytic Markov model with data on drug efficacy and toxicity from both the medical literature and a national randomized clinical trial. Drug costs were from average wholesale prices.

Social work perspectives in organ procurement.

The gap between the supply of and demand for organs for transplantation has widened in the past two decades, resulting in low quality of life and increased mortality for people waiting for a transplant. Current strategies for organ procurement are inadequate; therefore, alternative methods have been suggested. In the center of the debate are the required request strategy, which endorses the informed consent principle, and the presumed consent strategy, which assumes but does not require explicit consent from the donor.

Health-illness beliefs and practices of Haitians with HIV disease living in Boston.

The authors of this qualitative study explored the health-illness beliefs and practices of Haitians with HIV disease. The authors obtained a purposive sample of five Haitian men and four Haitian women with symptomatic HIV disease or AIDS living in Boston. Five themes were identified through content analysis of interviews and medical record review: (a) incorporation of traditional health-illness beliefs into beliefs about HIV disease; (b) A perceived need to hide HIV disease to avoid rejection, humiliation, and isolation; (c) use of spirituality to help cope with HIV disease; (d) history of limited contact with doctors prior to diagnosis of HIV disease; and (e) use of traditional healing practices for HIV disease.