Progressive obstructive lung disease associated with microscopic polyangiitis.

Small airway involvement and progressive severe airflow obstruction are unexpected features in patients with microscopic polyangiitis. We report the case of a patient with microscopic polyangiitis and circulating anti-neutrophil cytoplasmic antibodies (ANCA), who developed pulmonary hyperinflation and airflow obstruction over a 7-yr period. Systemic manifestations of this vasculitis improved under corticosteriods and cyclophosphamid therapy, a treatment that did not influence either the very high level of anti-myeloperoxidase antibodies or the ventilatory impairment. Small airway involvement was suspected on the basis of pathologic small airway lesions and a mild emphysematous pattern on computed tomography (CT) scan, which was out of proportion with the severity of the obstructive lung disease.

Fictitious twins, factitious illness.

Five patients who sought hospitalization with factitious illnesses also feigned or fantasied loss of a twin. This unusual presentation suggests the possibility that fantasied twin loss may have dynamic implications. The patients are described and discussed in relation to factitious illness, factitious bereavement, and twin fantasies. Their fictional twin bereavement appeared aimed, in part, at stabilizing a fragile sense of self and gaining sympathetic support from others. This presentation should alert one to investigate the story, inviting the person's participation in gaining corroborating information, and--should the story prove false--to support the individual in less victimizing adaptations.

Family dynamics in end-of-life treatment decisions.

The decision to withhold or withdraw life-sustaining treatment is now regularly weighed in chronic or terminal illness. Families are usually supportive advocates and concerned surrogate decision makers for patients, although they can also counter the wishes of the patient and disagree with the treatment team. Understanding the range of factors--internal and external, confronting the individual members and the family as a whole--that can influence family responses helps in working with families at this critical juncture in an illness. Interventions to assist the family and treatment team are discussed.

Endocapsular triple procedure--a new triple procedure technique.

The triple procedure (penetrating keratoplasty, cataract extraction, and intraocular lens implantation) performed using endocapsular cataract extraction and posterior chamber intraocular lens implantation offers advantages over the extracapsular technique. The most significant advantage is easier, assured placement of the posterior chamber intraocular lens entirely in the bag. Another advantage is less chance of injury to the endothelial cells. This paper describes a technique using endocapsular cataract extraction in the triple procedure.

Effect of excimer laser on microbiological organisms.

The effect of radiation emitted from an excimer laser filled with argon fluoride gas at 193 nm on Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus aureus, streptococcus faecalis, Hemophilus influenzae, Candida albicans, and Aspergillus niger (collectively labeled "the microorganisms") was examined. Colonies were subjected to a variable number of radiation pulses from the excimer laser applied after a 36-hour period of incubation at 37 degrees C, at which time the colonies were fully grown and showed no viability. The lack of viability was confirmed with a subculture from each area that received radiation; all subcultures were negative. The characteristics of the radiation paralleled those used by Serdavic, Darrell, Krueger, et al in 1985.(1) This radiation treatment is believed to be within a therapeutic range, which suggests that the excimer laser, pending further investigation, may be useful in the treatment of corneal infections.