Spirometry in normal subjects in sitting, prone, and supine positions.

Objective: Determine whether pulmonary function testing is affected by patient positioning.

Methods: In a descriptive study with measurements made in a sequential but randomized order at a university-based pulmonary function laboratory, 20 healthy men, ages 18-50 years, were evaluated with spirometric assessment of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and maximum voluntary ventilation (MVV) in the sitting, supine, and prone positions. Subjects were excluded for body mass index (BMI) > 30 kg/m2 or abnormal baseline spirometry.

Placental pathology casebook. Serpentine aneurysms of the placenta with fetal consequences.

Two cases of placental surface vessel aneurysms are presented. One case was associated with severe fetal intrauterine growth restriction and fetal thrombocytopenia. The other case was associated with "molar transformation" of placental villous tissue.

Organ transplantation: the role of the acute care nurse practitioner across the spectrum of health care.

Organ transplantation has become an accepted treatment method for a multitude of conditions once deemed untreatable. Increasing numbers of patients are treated by nurse practitioners before and after transplantation in a variety of settings, such as primary and specialty care clinics, urgent care, critical care units, and long-term care facilities. This article outlines the role of the acute care nurse practitioner in the management of adult transplant recipients in a variety of health care settings and reviews the problems and interventions specific to this patient group.

Bilateral facial nerve paralysis after high voltage electrical injury.

A case of bilateral facial nerve paralysis of a patient who received a high voltage electrical burn is presented. This is an extremely unusual neurologic condition and has not been previously reported in association with electrical injuries. The patient regained nearly complete neurologic function several months after the incident.

Safety and efficacy of TransCyte for the treatment of partial-thickness burns.

Standard treatment for extensive partial-thickness burns in the United States and in much of the world involves the application of topical antimicrobial agents and repetitive wound débridements and dressing changes. We evaluated a new biologic wound covering, TransCyte (Advanced Tissue Sciences, La Jolla, Calif, formerly marketed as Dermagraft-Transitional Covering), for the treatment of partial-thickness burns. This material is composed of human newborn fibroblasts which are then cultured on the nylon mesh of Biobrane (Dow B.

Comparison of resuscitation with diaspirin crosslinked hemoglobin (DCLHb) vs fresh blood in a rat burn shock model.

Diaspirin crosslinked hemoglobin (DCLHb; Baxter Healthcare Corp, Deerfield, IL) is hemoglobin-based oxygen carrier which, in our laboratory, improved hemodynamic parameters in a rat burn shock model. Our objective was to compare the effects on hemodynamic parameters and metabolic acidosis of resuscitation with different doses of fresh blood (FB) vs DCLHb. Male Wistar rats (200 to 250 g), surgically prepared for an acute study, were randomly assigned to one of five treatment groups.

Efficacy of MGI 114 (6-hydroxymethylacylfulvene, HMAF) against the mdr1/gp170 metastatic MV522 lung carcinoma xenograft.

Illudins are a novel class of agents with a chemical structure entirely different from current chemotherapeutic agents. A new semisynthetic derivative, MGI 114 (NSC 683,863, 6-hydroxymethyl-acylfulvene, HMAF), is markedly effective in a variety of lung, breast and colon carcinoma xenograft models. This analogue, MGI 114, is currently in phase I human clinical trials, and is scheduled for two different phase II trials.

Pulmonary hypertension and trisomy 16.

An infant girl, born small for gestational age, with abnormal single creases on the fifth digits, subsequent severe developmental delay, hypertelorism, bilateral equinovalgus deformities, grade IV genitourinary reflux and mild right hydronephrosis, was found to have an inverted duplication of the short arm of chromosome 16 [46,XX; inv dup (16) (p 13.3-->p 11.2].

A practical approach to designing and performing a focused study.

Designing and performing focused studies is part of the regular work of infection surveillance, prevention, and control, and the methodology of a prevalence survey used in this practice forum will be familiar to many infection control professionals. A practical example of a focused study to evaluate cost savings from extending intravenous catheter site and administration set change frequency from 72 hours to 96 hours illustrates the steps required. Suggested references for additional information are included at the end of the article.

The emerging role of contrast agents in echocardiography.

Because of an outstanding track record for diagnostic accuracy, noninvasive properties, ease of use, and relatively low expense, echocardiography has become a leading technique in the evaluation of cardiac disorders. In the three decades since echocardiography entered the ranks of standard cardiac diagnostic tools, refinements and technological advances have progressively increased its usefulness. One of the most noteworthy advancements has been the development of ultrasound contrast agents, which investigators are avidly seeking to apply to a broad spectrum of clinical settings and issues.

Who should manage CRRT in the ICU? The nursing viewpoint.

Continuous renal replacement therapy (CRRT) is performed in critical care units around the world with various levels of involvement from critical care and nephrology nurses. In this article, factors affecting the delivery of nursing care and the particular expertise nephrology and critical care nurses have in the area of CRRT are examined. Based on this discussion, three proposed models of nursing care for the patient receiving CRRT are discussed: the Nephrology Nursing Model, the Critical Care Model, and the Collaborative Model.

Percutaneous radiologic and endoscopic gastrostomy: a 3-year institutional analysis of procedure performance.

Objective: The study was designed to evaluate the safety, efficacy, and usefulness of the performance of percutaneous radiologic (PRG) and endoscopic (PEG) gastrostomy.

Materials And Methods: This study involved a retrospective review of 182 percutaneous gastrostomy procedures (68 PRG, 114 PEG) performed over a 3-year period. Parameters analyzed included technical success, procedure duration, anesthetic requirements, incidental findings on endoscopy, and complications.

Nitric oxide in respiratory failure in the newborn infant.

Nitric oxide given as an inhalation (INO) is a novel selective pulmonary vasodilator without effects on the systemic circulation. Preliminary observations indicated that INO treatment was associated with improvements in oxygenation in near-term newborn infants with hypoxic respiratory failure and persistent pulmonary hypertension of the newborn (PPHN). Subsequently, at least eight prospective randomized controlled trials evaluating the use of INO in the near-term neonate with hypoxic respiratory failure have been presented or published.

Patients' satisfaction when denied authorization for emergency department care by their managed care plan.

We conducted a survey of managed care plan (MCP) patients who presented to the emergency department (ED) but were denied insurance authorization during a 3-month period. Patients were identified by triage or registration records, contacted by telephone after their visit, and surveyed regarding their satisfaction with the ED and MCP, follow-up care, and future behavior. We surveyed 72 (73.

Familial occurrence of pulmonary atresia with intact ventricular septum.

Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare disease, accounting for less than 3% of all congenital heart lesions. The cause of PA/IVS is unknown. We report the occurrence of two first cousins with PA/IVS, suggestive of autosomal dominant inheritance with incomplete penetrance.

Transformation of a virulence associated gene of Haemophilus somnus into a strain lacking the gene.

The role of a 76 kDa surface antigen (p76) of Haemophilus somnus in virulence was investigated. The p76 gene from a virulent isolate of H. somnus (strain 2336) was introduced into an asymptomatic carrier strain (129Pt) lacking this gene.

Effect of drugs and cocaine metabolites on cocaine and cocaethylene binding to human serum in vitro.

The effect of amphetamine (AMPH), codeine (COD), methamphetamine (MEPH), morphine (MORP), and benzoylecgonine (BE) on the binding of cocaethylene (CE) and cocaine (COC) to human serum in vitro was investigated by equilibrium dialysis at 4 degrees C. Each compound was added individually at concentrations of 500, 1,000, or 2,000 nM to pooled human serum containing COC or CE at 500 nM concentration. For COC, the addition of COD, MEPH, and CE enhanced serum binding whereas MORP and BE decreased it.

Domestic violence in the emergency department: how do women prefer to disclose and discuss the issues?

The purpose of this study was to survey women presenting to the emergency department (ED) and determine from them how best to identify and discuss issues of domestic violence (DV). An anonymous 10-question survey was given to ambulatory females presenting to the ED. It was conducted at two affiliated university hospital EDs, one an urban trauma center (ED 1) and the other an ED in an affluent suburban setting (ED 2).

Analysis of chronic obstructive pulmonary disease referrals for lung volume reduction surgery. The University of California San Diego Emphysema Treatment Group.

Background: Preliminary results of lung volume reduction surgery (LVRS) for patients with severe emphysema are promising, although many issues regarding the selection process for LVRS are still unaddressed. For example, it is unclear which patients should be referred for pulmonary rehabilitation, lung transplantation, or LVRS, and whether health-care providers are optimizing conservative treatment options before referral for surgical intervention. The purpose of this analysis is to describe preliminary results of the evaluation process for LVRS implemented as part of an integrated, programmatic approach to the evaluation, treatment, and rehabilitation of patients with advanced emphysema.

Shortened survival after relapse in T-cell acute lymphoblastic leukemia patients with p16/p15 deletions.

p16 Alterations were detected in > 60% of 103 primary T-ALL samples. In paired diagnosis-relapse patient samples, 80% of the relapse samples with p16 deletion were deleted at diagnosis. When p16 was homozygously deleted, p15 gene alterations were found in 72% of the diagnosis T-ALL patient samples, increasing significantly to 100% at relapse.

Current concepts in electrical defibrillation.

The electrical defibrillator has been proven to be a life-saving device in the treatment of cardiac arrest due to ventricular tachycardia or ventricular fibrillation. An understanding of the physiology and technology behind this device is useful for providers of emergency care. In this article, we review the current concepts in electrical defibrillation and briefly discuss the developmental history.

Pregnant and parenting adolescents and their younger sisters: the influence of relationship qualities for younger sister outcomes.

On the basis of social modeling theory and a sibling interaction hypothesis, it was hypothesized that specific relationship qualities between a pregnant or parenting teen and her younger sister would be associated with permissive younger sister outcomes, such as permissive childbearing attitudes and permissive sexual behavior. Results indicated that negative relationship qualities, such as rivalry, competition, and conflict, were more closely related to younger sisters engaging in problem delinquent-like behavior and sexual behavior than were positive relationship qualities, such as warmth and closeness. Additionally, a shared friendship network with the older sister was found to be associated with extensive younger sister problem behavior and sexual behavior.

Neuropeptide Y-mediated pressor responses following high-frequency stimulation of the rat sympathetic nervous system.

Neuropeptide Y (NPY) is a potent pressor agent that is stored in the sympathetic nerves. In several species, NPY release is augmented when sympathetic impulse frequencies increase. We investigated the extent to which NPY contributes to the pressor response to high- and low-frequency electrical stimulation.