A rapid and inexpensive method for processing induced sputum for detection of Pneumocystis carinii.

The authors describe a method to process induced sputum specimens for detection of Pneumocystis carinii which is simple, rapid and inexpensive. Induced sputum and bronchoalveolar lavage (BAL) were obtained within a 24-hour period from 41 patients who were HIV-positive and had pulmonary symptoms suspicious for P carinii pneumonia. Induced sputum or BAL fluid was placed into Saccomanno's fixative, blended, and centrifuged. The sediment was stained for P carinii cysts by a modified method with Fungi-Fluor Solution A (Polysciences, Warington, PA) and the Genetic Systems Pneumocystis carinii Immunofluorescence Antibody (Genetic Systems, Seattle, WA). The Genetic Systems stain on the BAL specimen was positive in 35 patients and was the standard for comparison. With a single induced sputum, the Genetic Systems stain detected 31 (89%) positive patients, whereas the Fungi-Fluor stain detected 21 (60%). The sensitivity for detecting P carinii cysts in induced sputum was significantly greater (P < 0.05) for the Genetic Systems stain.

Deep vein thrombosis: significant limitations of noninvasive tests.

Impedance plethysmography (IPG) has a reputed sensitivity of 95% in the detection of proximal, clinically significant deep venous thrombosis (DVT). A review of the radiologic studies of 100 consecutive patients who underwent both venography and IPG showed venographic evidence of proximal DVT in 40 patients. The IPG was negative in 15 (38%) of these 40 cases. The specificity of the IPG was 83%. The predictive value of a negative study, with this 40% prevalence of DVT, was 77%. These disturbing results indicate a continuing role for venography in the workup of DVT.

Popliteal entrapment syndrome.

A case of a type of popliteal entrapment syndrome that does not include an anomalous course of the popliteal artery is presented. In situ thrombosis secondary to entrapment-induced stasis was the presumed cause of ischemic symptomatology. Thorough knowledge of the possible causes of entrapment and biplane angiography (of the popliteal artery) with provocative maneuvers often are required for diagnosis. As in our patient, surgical release of the entrapment can lead to complete resolution of symptoms.

The radiology of osteomyelitis.

In the early stages of acute osteomyelitis, bone scanning is especially helpful. It is important to correlate the bone scan with clinical findings because the scan is nonspecific. Radiograms reveal the extent of disease, but may lag behind clinical findings; however, plain film studies may reveal sequestra not seen by other means. Gallium scanning may be of value in osteomyelitis, as may be computerized tomography.

Career counseling as experienced by practicing black ophthalmologists.

This study was undertaken as an effort to begin to understand the phenomenal dearth of black physicians in the United States, particularly those practicing the specialty of ophthalmology, and to what extent those who were successful had exposure to career counseling.A QUESTIONNAIRE WAS SENT TO A RANDOM SAMPLE OF THE PRACTICING BLACK OPHTHALMOLOGISTS IN THE COUNTRY IN AN EFFORT TO ACQUIRE THE FOLLOWING DATA: demographic-geographic, socioeconomic, institutional characteristics, level of counseling interaction, and the variables in specialty choice.The compiled data indicated that the majority of respondents were born and raised in the South in households headed by professionals earning $5,000 per year. They attended all-black schools where career counseling per se did not exist except in the form of teacher assistance or parental pressure.At the college and university level, there was again a lack of counseling services and the faculty served as the motivating agents. Several institutions were mentioned as having been particularly helpful with guidance from concerned faculty members. Medical schools, excluding Meharry and Howard, also appeared to have inadequate counseling for black students.It is recommended that more black secondary students be placed in college preparatory programs and suggested that colleges and universities provide increased counseling services for blacks and that those enrolled in premedical courses receive more assistance from biology and chemistry faculties. Black faculty members should be added to counselor education programs and at counseling centers. Medical schools should commit themselves to upgrading their services to blacks they so heavily recruit. Additional studies are necessary to attempt to ascertain other variables which continue to preclude any appreciable gains in the number of practicing black physicians.