Applying sputum as a diagnostic tool in pneumonia: limited yield, minimal impact on treatment decisions.

Study Objectives: We evaluated the role of sputum examination in the management of patients with community-acquired pneumonia (CAP) in a primary-care hospital without microbiologic laboratory facilities.

Design And Interventions: A diagnostic strategy using regular collection of sputum samples, Gram staining in a local laboratory, and mailing of samples to a commercial laboratory for culture analysis.

Setting: A 200-bed primary-care hospital without subspeciality physicians.

Flexible bronchoscopy in nosocomial pneumonia.

In this article, an overview on the diagnostic performances of bronchoscopic techniques for the diagnosis of nosocomial pneumonia is given with special emphasis on the inherent problems of the methodology of validation applied to different studies. The current evidence about the importance of bronchoscopic techniques for the outcome is reviewed. It is outlined that future prospects of bronchoscopic investigations mainly include the evaluation of its role in the reassessment of the patient with pneumonia not responding to the initial antimicrobial treatment.

Management of patients with community-acquired pneumonia in a primary care hospital: a critical evaluation.

The aim of the study was to evaluate routine management of patients with community-acquired pneumonia (CAP) with regard to severity patterns, diagnostic approaches and results, as well as initial empiric antimicrobial treatment and its impact on outcome. Two hundred and thirty-two consecutive patients with CAP admitted to a primary care hospital were studied prospectively. Patients were classified according to Fine's severity score.

[Cardiovascular morbidity in patients with obstructive sleep apnea in relation to the severity of respiratory disorder].

Basic Problem And Objective: Untreated patients with obstructive sleep apnoea (OSA) have an increased risk of death from cardiovascular (cv) disease. This study was undertaken to determine the disease spectrum in patients with sonographically proven OSA (apnoea-hypopnoea index > or = 5), with special reference to cv risk factors and accompanying diseases in relation to the severity of their respiratory abnormalities. The study's aim was to clarify what risk factors and accompanying diseases were associated with different degrees of OSA.

[QT syndrome: new diagnostic possibilities].

Electrocardiographic and clinical characteristics are currently used as diagnostic criteria for the long QT-syndrome. In borderline electrocardiographic findings associated with unclear syncope, it is often difficult to ensure or exclude long QT-syndrome. Schwartz and coworkers therefore created a point system as a guide in clinical decision making.

[Atrial defibrillator].

Atrial fibrillation (AF) is a frequent and costly health care problem representing the most common arrhythmia resulting in hospital admission. Total mortality and cardiovascular mortality are significantly increased in patients with AF compared to controls. In addition to symptoms of palpitations patients with AF have an increased risk of stroke and may also develop decreased exercise tolerance and left ventricular dysfunction.

[Quantitative cultures in diagnosis of pneumonia--a method for routine practice?].

Quantitative cultures of respiratory secretions represent a valid technique for the diagnosis of ventilator-associated pneumonia. Contamination, colonization and true infection can be differentiated with a reasonable specificity using established cut-offs of bacterial colony counts. Quantitative investigations provide local epidemiological databases as a framework for empirical antimicrobial policies and may also prove helpful in the guidance of individual antimicrobial therapy.

[Increased apoptosis and necrosis of coronary plaques in unstable angina].

In acute coronary syndromes, arteriosclerotic plaques are characterized by inflammation and decreased smooth muscle cell density. The underlying pathogenic processes remain unclear. Among others, increased programmed cell death (apoptosis) is postulated.

[Sleep apnea as a risk marker in coronary heart disease].

Unlabelled: Obstructive sleep apnea (OSA) and coronary heart disease (CHD) are both frequent in the middle ages. Both disease share a similar spectrum or risk factors and attendant diseases. The aim of the study was to determine the prevalence of obstructive sleep apnea in patients with coronary heart disease diagnosed by coronary angiography.

[Improved prognosis of first episode HIV associated Pneumocystis carinii pneumonia without preventive treatment: etiology and sequelae].

Objective: The prognosis of first episodes of HIV-associated PCP has markedly improved. The knowledge about the reasons for this progress could bear important implications for the management of HIV-infected patients.

Patients And Methods: Clinical and laboratory parameters, as well as therapy and clinical course were documented.

[Intra-atrial defibrillation--limits and possibilities].

Unlabelled: External cardioversion has been a remarkably effective and safe method for termination of atrial fibrillation. Originally introduced by Lown and coworkers in 1962, it has been an accepted mode of acute therapy. The disadvantages of this approach are the need for general anaesthesia and the demand for high energies up to 360 J.

[Exogenous adenosine as an anti-arrhythmia agent].

Adenosine has potent cardiac electrophysiologic effects including a negative chronotropic action on the sinus node and a predominant negative dromotropic action on the AV node. The latter property has mainly led to the use of adenosine as antiarrhythmic agent for the acute management of paroxysmal supraventricular tachycardia (PSVT) mediated by a reentrant mechanism involving the AV node. The effects of adenosine are dose-dependent and of very short duration since the half-life is less than 10s.

[Sleep apnea and cardiovascular risk].

Obstructive sleep apnea syndrome (OSAS) is the most important form of sleep-related breathing disorders due to its high prevalence and its potential for developing cardiovascular diseases. The increased morbidity of these patients is explained by the coincidence with cardiovascular diseases, and the increased mortality of untreated patients is due to cardiovascular complications, which depend on the degree of the breathing disorder. Heavy snoring, as a partial obstruction of the upper airways, and OSAS are independent risk factors for the development of cardiovascular diseases and stroke.

[Ultrasound anatomy of the fetal hip joint with special reference to the blood supply].

Aim: Study of the anatomy of the fetal hip joint in 115 pregnancies between 13. to 40.th weeks of gestation by ultrasound.

[Sleep-related respiratory disorders in patients with implantable cardioverter/defibrillator devices--relationship between left ventricular function and respiratory disorder].

In order to detect sleep related breathing disorders (SRBD), 15 patients (6 with dilated cardiomyopathy [DCM], 9 with coronary heart disease [CHD], mean age 58 +/- 13 years) with implantable cardioverter/defibrillator [ICD] underwent polysomnography. A SRBD could be diagnosed in 27% of cases (n = 4; 3 DCM, 1 CHD). The reduction of the ejection fraction (EF) (normal, mild-to-moderate and severe, respectively) and the quality of sleep-related disturbances (normal, obstructive, and central/periodic) were significantly associated.

[Methods, topography and mechanisms of radiofrequency ablation of AV-nodal reentry tachycardia].

Three different methods of radiofrequency catheter ablation of AV nodal reentrant tachycardia were investigated in 128 patients. Results, relapses, and complications using anterior approach (n = 15), moved catheter (n = 20), and posterior-inferior approach (n = 93) were compared. Eight mechanisms of ablation of AV nodal reentrant tachycardia were distinguished: 1) Ablation of fast pathway (n = 8), 2) of slow pathway (n = 22), 3) modification of fast (n = 12), 4) slow (n = 54), or 5) both pathways (n = 13), 6) Ablation of fast and modulation of slow pathways (n = 4), 7) ablation of slow and modulation of fast pathways (n = 12), and 8) ablation of both pathways (n = 3).