Orolaryngeal sarcoidosis presenting as obstructive sleep apnoea.

A 53-year-old man was evaluated for snoring, dysphagia for solid foods and difficulty of breathing and a polysomnographic recording was consistent with a diagnosis of obstructive sleep apnoea syndrome (OSAS). A flexible fiberoptic bronchoscopy (FFB) showed the presence of a nodular lesion of the posterior ventral surface of the tongue strictly connected to the left lateral border of the epiglottis. The biopsy specimen taken from the lesion was consistent with sarcoidosis. No involvement of pulmonary parenchyma, lymph nodes or other organs was recognized. After two months of steroid treatment, symptoms disappeared and resolution of the nodular lesion at the FFB and normalization of the polysomnographic recording were observed. This is the first report of orolaryngeal sarcoidosis associated with OSAS as the only clinical presentation of the disease.

Primary Care Health Information System: a hybrid electronic-paper medical record system.

In summary, PCHIS is a hybrid electronic-paper medical record system that is clinically useful to health care providers. The paper chart still contains the bulk of information but the key facts about any given patient (diagnoses, surgeries, medications, allergies) and about the process of care (frequency of visits, referral patterns, test ordering, etc.) are readily available in electronic form. These key data are easily coded, are quickly and simultaneously accessible in multiple locations, serve as an excellent chart substitute whenever the paper chart is unavailable, and can be retrieved for in-depth analysis at any time, whether for clinical, administrative, research, or quality assurance purposes. The process of care can be studied and, to some extent, can also be modified by the system, as demonstrated by the physician response to the reminder system within PCHIS. The medical record chart summary, mandated by Joint Commission for ambulatory patient charts, is easily provided in hard copy as well as electronically. Whereas physician compliance in providing data to the system was initially sporadic, physician support has increased tremendously as the system has become more clinically useful to them. It is a system that exists and functions well within a patchwork of multiple different medical information systems. It is a system with sufficient intrinsic flexibility that it can and will continue to evolve in response to the needs of physicians and administrators.

Physician attitudes toward cost containment. The missing piece of the puzzle.

A survey of 720 physicians practicing in central and western Massachusetts was undertaken to examine their attitudes toward cost-containment measures. The majority of physicians felt that major techniques (58%), major procedures (57%), inappropriate ordering of diagnostic tests (48%), and malpractice concerns (47%) were very important contributors to increasing health care costs. Physician age, practice affiliation, and specialty area were related to the perceived importance of these factors. In addition, while there was a uniform lack of prior training in cost-containment measures, 48% of all physicians felt that courses in cost-containment techniques would be worthwhile. These results suggest a variety of concerns and issues that need to be considered when attempting to modify the cost-containment attitudes and practices of physicians.

Presumptive evidence for Blastocystis hominis as a cause of colitis.

A patient with persistent diarrhea was found to have biopsy-proved colitis with large numbers of the protozoan Blastocystis hominis present in stool. Extensive evaluation failed to reveal any other potential etiologic agent of acute colitis. Following treatment with a course of metronidazole, the patient became asymptomatic, B hominis was no longer present in stool, and results of a repeated biopsy were normal. These observations are consistent with the role of B hominis as a gastrointestinal pathogen.

Ampicillin inhibits biliary cholesterol secretion.

There are compounds, other than bile salts, which influence biliary lipid composition. For example, the organic anions, bilirubin, and BSP, are secreted into bile and depress biliary phospholipid and cholesterol secretion. Ampicillin is also secreted into bile, but its effects on biliary lipid secretion are unknown. Therefore we measured biliary lipid secretion before, during, and after an ampicillin infusion. We infused bile salt pool depleted rats with a constant infusion of taurocholate. After biliary lipid secretion reached a steady state, the ampicillin solution was infused in a stepwise fashion. Within minutes after starting the ampicillin, bile flow and biliary ampicillin secretion increased. Simultaneously, biliary phospholipid and cholesterol, but not bile salt, secretion decreased significantly. The calculated lithogenic index of bile decreased significantly as well. Despite doubling the ampicillin infusion, neither biliary ampicillin, phospholipid, nor cholesterol secretion changed. After discontinuation of the ampicillin, bile flow and biliary ampicillin secretion decreased, while phospholipid and cholesterol secretion returned to normal. Ampicillin dramatically influences biliary lipid composition directly. It inhibits the biliary secretion of phospholipid and cholesterol, but not bile salt, and consequently reduces the molar percentage of cholesterol in bile.

Developmental body of composition of the squirrel monkey (Saimiri sciureus).

The longitudinal growth of 69 newborn squirrel monkeys fed control semipurified diets from birth as well as the developmental chemical analysis of 51 carcasses is reported. Males were significantly heavier than females at birth and every age thereafter. Exponential curves fitted to the first two years of life in each sex showed that age and weight were highly correlated (R2 = 0.999). Therefore, the four major carcass components (water, protein, fat and ash) were expressed as a function of a single variable--body weight. Water and protein content were linearly related to body weight over a wide range of growth whereas fat and ash were more variable. Using linear regression analysis, no sex differences were found. On a percentage basis, body fat content was uniformly low (2.7%) at birth and increased to variable levels thereafter. Therefore, the subsequent analyses were done on a fat-free basis. Per cent protein (nitrogen X 6.25) increased from 16.3 at birth to 23.8% at adulthood with water decreasing from 76.4 to 68.9%. The protein:water ratio was 0.213 at birth and increased to an adult value of 0.345. The developmental curves indicated that approximately 70 to 75% of this maturation occurred in the first 3 weeks of life and was completed on, or before, 20 weeks of age. Per cent ash increased significantly from 4.41 at birth to 5.10% at adulthood.