In COPD patients, body weight excess can mask lean tissue depletion: a simple method of estimation.

Although a great number of studies have been carried out on the relationship between chronic obstructive pulmonary disease (COPD) and low body weight, the identification of the most suitable warning signs of this wasting condition is still under debate. It has been indicated in earlier studies that body weight alone is of limited diagnostic value concerning this clinical condition in as far as a great number of COPD patients are usually overweight. For this reason, the aim of the current research was to find parameters that take into consideration the fact that body composition should be taken into account instead of weight only, and to assess whether COPD can be considered a "protein wasting disease", defining sensitive and significant indices of lean tissue depletion in relationship to the severity of the clinical symptoms. One hundred and seventy-five stable COPD outpatients with differing degrees of bronchial obstruction and arterial blood gas abnormalities were consecutively recruited: anthropometric measurements and body composition analysis were carried out; 60 healthy subjects with normal pulmonary function, matched for sex, age and anthropometric parameters, were considered as controls. The data obtained showed a lower prevalence (9%) of underweight COPD patients in comparison with normal weight (37%) and overweight (54%) patients. In COPD patients, the phase angle measured by bioelectrical impedance analysis, whose deterioration is a good indicator of protein mass depletion, was altered by 19%, thus allowing the identification of currently malnourished subjects included in the overweight COPD patients group. In addition, significant correlations (p = 0.000) were found between the same nutritional variable, respiratory function and gas-exchange parameters, thus confirming that the more severe the stage of the pulmonary disease, the higher the degree of protein breakdown, regardless of body weight.

Validation of a new technique to assess exhaled hydrogen peroxide: results from normals and COPD patients.

Chronic airways inflammation in chronic obstructive pulmonary disease (COPD) induces the activation of several cell types with delivery of proteases and reactive oxygen species (ROS). Assessing oxidant content in the exhaled air of COPD patients has proven useful in monitoring airway inflammation. The present study was designed to confirm the usefulness of exhaled hydrogen peroxide concentration determination in COPD patients using a new technique which allows longer storage of the expired air condensate before the H2O2 assay. The technique was applied in 13 healthy nonsmoking subjects (six male, age range 22-40 yrs) and in seven patients (five male, age range 58-81 yrs) with mild or moderate COPD. Subjects breathed into a one-valve mouthpiece, and the exhaled air was directed into a vial kept at 0 degree C. After approximately 15 min of quiet breathing, 1 mL of expired air condensate was collected. An aliquot, 450 microL, of this sample was immediately added to an equal volume of a reaction mixture containing 2 mM 3,5,3',5'-tetramethylbenzidine and 40 microL of enzyme stock solution (0.5 mg.mL-1). After 15 min, 45 microL sulphuric acid was added (1 N final concentration), resulting in a reaction mixture pH of 1.0. After a further 10-min incubation, H2O2 concentration determination was performed spectrophotometrically at 450 nm. This solution, as well as the H2O2 assay, was stable for > or = 24 h if the sample was kept in the dark and at 4 degrees C. There was high stability on repeated measures, with a coefficient of variation equal to zero. The mean +/- SD H2O2 level in exhaled air from normal subjects was 0.12 +/- 0.09 microM, whereas it was significantly increased in COPD patients (0.50 +/- 0.11 microM; p = 0.0001 compared to healthy subjects). In three healthy control subjects, a normal H2O2 level in expired air increased to 0.70-0.80 microM during an acute upper respiratory tract infection. This new technique of hydrogen peroxide assay in expired air condensate greatly minimizes the inaccuracy deriving from the instability of hydrogen peroxide. The preliminary results obtained using this technique provide direct evidence for increased reactive oxygen species production in the airways of stable chronic obstructive pulmonary disease patients. However, the specificity of the procedure could be reduced by the interference of upper respiratory tract infections.

How accurate are waiting time perceptions of patients in the emergency department?

STUDY OBJECTIVE: To assess the ability of patients to accurately estimate specific waiting times in the emergency department. METHODS: A questionnaire was administered by telephone to a random sample of 776 patients (or parents or responsible caretakers, if appropriate) who had been treated within the previous 2 to 4 weeks in the ED of a suburban hospital. Respondents were asked their perceptions of two particular time frames: (1) the time elapsed from triage until initial examination by the emergency physician (physician waiting time [PWT]), and (2) the time elapsed from triage until departure from the ED (total waiting time [TWT]). Corresponding actual times were extracted from a computerized database. Time frames were divided into discrete periods for comparison. The correspondence between actual and perceived times was assessed by optimal data analysis. RESULTS: Only 22.3% of the respondents accurately estimated PWT. Although this level of accuracy is statistically significant (P < .0001), it reflects only 11% of the theoretically possible improvement in accuracy beyond chance. More respondents overestimated than underestimated PWT (49.9% versus 27.8%, respectively). In contrast, TWT was accurately estimated by 36.6% of the respondents (P < .0001), reflecting 18% of the theoretically possible improvement in accuracy beyond chance. Fewer respondents overestimated than underestimated TWT (24.5% versus 38.9%, respectively). CONCLUSION: Patients are not very accurate in their estimation of actual waiting times. Although fewer than one fourth of the respondents overestimated the TWT spent in the ED, almost half the respondents overestimated the PWT.

Microcomputer voice-recognition program in a hospital emergency department.

A software program for voice-controlled text creation was used on a microcomputer in the emergency medical department of a large hospital. It was found that automated speech recognition (ASR) permitted doctors to produce their reports faster and more accurately than handwriting or dictation to tape. In addition, ASR reporting is cheaper than dictation to tape. Other advantages include the automatic creation of computer-stored patient files that can be used for statistical purposes. There were a few minor drawbacks, including the need for a procedure for training the system to recognize the user's voice.

[Sarcoid febrile hepatic granulomatosis. Description of a case associated with initial liver cirrhosis]. / Granulomastosi epatica febbrile sarcoidotica. Descrizione di un caso con associata cirrosi iniziale del fegato.

A case of febrile hepatic granulomatosis was examined and the many aetiologies to be considered in the differential diagnosis of the condition evaluated. This is not a separate disease but a specific histological peculiarity of the liver. The case in question was diagnosed as hepatic granulomatosis originating in sarcoidosis. This diagnosis requires, it is though, the presence of characteristic granulomas in the liver biopsy sample but more important in the Kweim reaction or preferably in more specific tissue biopsies (spleen, lymph nodes, mesentery). In the present case the histologically revealed initial cirrhosis may be purely concomitant though certain authorities believe that sarcoidotic hepatic granulomas may develop into cirrhosis.